**Archived Information**

**Application Instructions**

**for State Grants**

**Fiscal Year 2001**

![](media/image1.wmf){width="3.8in" height="3.5277777777777777in"}

**U.S. Department of Education**

**Office of Elementary and Secondary Education**

**Reading Excellence Program**

**Washington, D.C. 20202-6200**

**CFDA Number 84.338A**

**Form Approved: OMB No. 1810-0616**

**Expiration Date: March 31, 2003**

**DATED MATERIAL -- OPEN IMMEDIATELY**

**Closing Date: May 4, 2001**

**Table of Contents**

Introduction [3](#introduction)

Federal Register Notice Inviting Applications
[4](#federal-register-notice-inviting-applications)

Instructions for Transmitting Applications
[8](#instructions-for-transmitting-applications)

Applications Sent Electronically [8](#applications-sent-electronically)

Applications Sent by Mail Only [9](#applications-sent-by-mail-only)

Applications Delivered by Hand/Courier Service:
[10](#applications-delivered-by-handcourier-service)

Instructions for Preparing the Application - Overview
[11](#instructions-for-preparing-the-application---overview)

Application Format and Length [11](#application-format-and-length)

Application Organization [12](#application-organization)

Discretionary Grant Forms [12](#discretionary-grant-forms)

Equitable Access and Participation - Section 427 of the General
Education Provisions Act (GEPA)
[13](#equitable-access-and-participation---section-427-of-the-general-education-provisions-act-gepa)

Selection Criteria [14](#selection-criteria)

Regulatory Requirements [16](#regulatory-requirements)

Absolute priority for focus on K-3 and related services and programs:
[16](#absolute-priority-for-focus-on-k-3-and-related-services-and-programs)

Competitive priority on teacher certification requirements
[16](#competitive-priority-on-teacher-certification-requirements)

Application Outline [17](#application-outline)

Supplemental Budget Form [19](#supplemental-budget-form)

Application Checklists [20](#application-checklists)

Legislative Compliance Checklist [21](#legislative-compliance-checklist)

Requirements from GEPA and Other General Education Legislation and
Regulations
[23](#requirements-from-gepa-and-other-general-education-legislation-and-regulations)

Checklist for Reading and Literacy Partnership
[24](#checklist-for-reading-and-literacy-partnership)

Checklist for Teacher Certification (competitive priority)
[25](#checklist-for-teacher-certification-competitive-priority)

Guidance on Section 427 of the General Education Provision Act
[26](#guidance-on-section-427-of-the-general-education-provision-act)

Standard Forms for Discretionary Grant Applications
[28](#standard-forms-for-discretionary-grant-applications)

Estimated Public Reporting Burden
[49](#estimated-public-reporting-burden)

Intergovernmental Review of Federal Programs
[50](#intergovernmental-review-of-federal-programs)

State Single Points Of Contact [51](#state-single-points-of-contact)

Note: Copies of standard forms are available at the U.S. Department of
Education\'s website at:

> <http://www.ed.gov/fund/grant/apply/appforms/appforms.html>

# Introduction 

> ![](media/image2.wmf){width="1.7in" height="1.7in"}

**Dear Applicant:**

Thank you for your interest in the Reading Excellence Program. The
Reading Excellence Act amended Title II of the Elementary and Secondary
Education Act of 1965 by adding support for implementing research-based
reading instruction in high poverty schools or schools needing
improvement. This program provides competitive grants to state education
agencies.

The Reading Excellence Act places an emphasis on the importance of
scientifically based research, including findings related to phonemic
awareness, vocabulary and background knowledge, systematic phonics,
fluency, reading comprehension, and motivation, in carrying out these
activities. The Reading Excellence Act legislation requires that in
order to apply the state educational agency must have a reading and
literacy partnership. State educational agencies that receive an award
will competitively subgrant to local education agencies for local
reading improvement programs and tutorial assistance programs. The
primary activities to be supported by grants are: (1) professional
development for teachers and principals; (2) early intervention such as
tutoring and transition programs for kindergarten students; and (3)
family literacy.

Included in this application booklet are the instructions and forms
needed to submit a complete application to the U. S. Department of
Education. This booklet includes information on funding available in FY
2001, the selection criteria and priorities for evaluating applications,
and a copy of the Notice Inviting Applications which provides important
information regarding the FY 2001 grant competition.

For more information about other U.S. Department of Education grant and
contract opportunities, we encourage you to use the Department's
electronic bulletin board and new EDNET service. The bulletin board data
number is (800) 222-4922 (modem access), and the EDNET service can be
accessed on the Internet at [www.ed.gov](http://www.ed.gov/).

We look forward to receiving your application and appreciate your
interest in promoting reading excellence in American education through
implementation of research-based reading instruction.

> **Nancy Rhett**
>
> **Director, Reading Excellence Program**
>
> **Office of Academic Improvement and Demonstration Programs**
>
> **Office of Elementary and Secondary Education**

# Federal Register Notice Inviting Applications

> **DEPARTMENT OF EDUCATION**

**(CFDA No. 84.338A)**

**Reading Excellence Program**

ACTION: Notice Inviting Applications for New Awards for Fiscal Year (FY)
2001.

[PURPOSE OF PROGRAM]{.underline}: The Reading Excellence Program
provides competitive grants to eligible State educational agencies to
award competitive subgrants to local educational agencies to fund local
reading improvement programs and tutorial assistance programs.

[ELIGIBLE APPLICANTS]{.underline}: State educational agencies (SEAs)
that were not funded in FY 1999 or FY 2000; Puerto Rico; the Virgin
Islands; Guam; American Samoa; and the Commonwealth of the Northern
Mariana Islands.

[APPLICATIONS AVAILABLE]{.underline}: March 23, 2001.

[DEADLINE FOR TRANSMITTAL OF APPLICATIONS]{.underline}**:** May 4, 2001.

[NOTE]{.underline}: An application for an award may be submitted by
electronic mail (email), regular mail, or hand delivery.

[Special instructions for applications submitted by email]{.underline}:
Applications submitted by email should include an electronic return
receipt and should be emailed to:

> <grantspolicy@ed.gov>

Applications submitted by email may be submitted in one of the following
formats: (1) Microsoft Word (Version Word 95 or Word 97) or (2) portable
document format (PDF). The preferred version is Word 97; however, all
versions must have text search capability. The electronic version will
be the official file copy. The returned receipt and copy will be
considered proof of receipt. All forms requiring original signatures
(ED-424, Application for Federal Education Assistance; SF 424B,
Assurances: Non-Construction Programs; ED 80-0013, Certifications
Regarding Lobbying, Debarment, Suspension and other Responsibility
Matters; and Drug-Free Workplace Requirements; ED 80-0014, Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary
Exclusion--Lower Tier Covered Transactions; and Form LLL, Disclosure of
Lobbying Activities) must be mailed to the Department by the deadline
date, as set out above under the DEADLINE FOR TRANSMITTAL section.
Please send a hard copy of your application in addition to the
electronic copy to ensure that your application is formatted properly
when printed.

[NOTE]{.underline}: Some of the procedures in these instructions for
transmitting applications differ from those in 34 CFR 75.102 (EDGAR).
Under 5 U.S.C. 553, the Department generally offers interested parties
the opportunity to comment on proposed regulations. However, these
exceptions to EDGAR make procedural changes only and do not establish
new substantive policy. Therefore, under 5 U.S.C. 553(b)(A), the
Secretary has determined that proposed rulemaking is not required.

[DEADLINE FOR INTERGOVERNMENTAL REVIEW]{.underline}**:** May 22, 2001

[ESTIMATED AVAILABLE FUNDS]{.underline}**:** \$316,495,390

[ESTIMATED RANGE OF AWARDS]{.underline}**:** \$500,000 - \$60,000,000.

[ESTIMATED AVERAGE SIZE OF AWARDS]{.underline}: \$21,125,693.

[ESTIMATED NUMBER OF AWARDS]{.underline}: 15.

[PROJECT PERIOD]{.underline}: Up to 36 months.

[MINIMUM GRANT AWARD FOR SEAs]{.underline}**:** \$500,000 for SEAs,
\$100,000 minimum for territories

[NOTE]{.underline}: The Department is not bound by any estimates in this
notice.

[PAGE LIMIT]{.underline}: The application narrative (Part III of the
application) is where you, the applicant, address the selection criteria
reviewers use to evaluate your application. You must limit Part III to
the equivalent of no more than 100 pages, using the following standards:

• A page" is 8.5\" x 11\", on one side only, with 1\" margins at the
top, bottom, and both sides.

• Single space (no more than six lines per vertical inch) all text in
the application narrative.

• Use a font that is either 11-point or larger or no smaller than 10
pitch (characters per inch).

The page limit does not apply to Part I, the cover sheet; Part II, the
budget section, including the narrative budget justification; Part IV,
the assurances and certifications; or the one-page abstract, the
resumes, the bibliography, the letters of support or the two permissible
appendices. However, you must include all of the application narrative
in Part III.

Our reviewers will not read any pages of your application that:

-   Exceed the page limit if you apply these standards; or

-   Exceed the equivalent of the page limit if you apply other
    standards.

[APPLICABLE REGULATIONS]{.underline}**:** (a) The Education Department
General Administrative Regulations (EDGAR) in 34 CFR Parts 75, 77, 79,
80, 81, 82, 85, 86, 97, 98, and 99; (b) 34 CFR and Part 299.

[FOR APPLICATIONS AND FURTHER INFORMATION]{.underline}: Send an email
message requesting an application to:

> reading_excellence@ed.gov

You may also receive an application by downloading it from the reading
excellence website:

> <http://www.ed.gov/offices/OESE/REA/index.html>

or by contacting Nancy Rhett, U.S. Department of Education, 400 Maryland
Avenue, SW, Room 5C141, Washington, DC 20202-6200; Telephone: (202)
260-8228. If you use a telecommunications device for the deaf (TDD), you
may call the Federal Information Relay Service (FIRS) at 1-800-877-8339.

Individuals with disabilities may obtain this document in an alternative
format (e.g., Braille, large print, audiotape, or computer diskette) on
request by contacting Katie Mincey, Director, Alternate Format Center,
330 C St. SW, Room 1000, Washington, DC 20202-4560; by calling (202)
260-9895 or 205-8113; or by emailing:

<katie_mincey@ed.gov>

Individuals with disabilities also may obtain a copy of the application
package in an alternate format by contacting Ms. Mincey. However, the
Department is not able to reproduce in an alternate format the standard
forms included in the application package.

[Electronic Access to This Document]{.underline}**:**

You may view this document, as well as all other Department of Education
documents published in the [Federal Register]{.underline}, in text or
Adobe Portable Document Format (PDF) on the Internet at either of the
following sites:

http://www.ed.gov/news/fedregister/index.html

http://www.ed.gov/news/fedregister/announce/index.html

To use the PDF file you must have the Adobe Acrobat Reader Program,
which is available free at either of the preceding sites. If you have
questions about using the PDF, call the U.S. Government Printing Office
(GPO), toll free at 1-888-293-6498; or in the Washington, D.C., area at
(202) 512-1530.

NOTE: The official version of this document is the document published in
the [Federal Register]{.underline}. Free Internet access to the official
edition of the [Federal Register]{.underline} and the Code of Federal
Regulations is available on GPO Access at:

http://access.gpo.gov/nara/index.html

[PROGRAM AUTHORITY]{.underline}: 20 U.S.C. 6661 et seq.

Dated:

> **Thomas M. Corwin**
>
> **Acting Deputy Assistant Secretary**
>
> **For Elementary and Secondary** **Education**

# Instructions for Transmitting Applications

An application for an award may be submitted electronically, mailed, or
hand-delivered by the closing date. The preferred form of submission is
by electronic transfer. Applications may not be faxed.

1.  **Applications submitted electronically must be received by midnight
    of the closing date.**

2.  **Applications sent by mail must be postmarked by the closing
    date.**

3.  **Applications that are hand-delivered must be received before the
    Application Control Center closes on the closing date. The hours of
    operation for the Application Control Center are Monday through
    Friday, 8:00 a.m. - 4:30 p.m. Eastern Standard Time. If a Courier
    Service is used, the Courier Service must be in receipt of the
    application on or before the closing date.**

*Note: Only materials postmarked, electronically transferred or hand
delivered by the closing date will be sent to the review panel.*

## Applications Sent Electronically

Applications submitted electronically should include an electronic
return receipt. The electronic mailing address is: grantspolicy@ed.gov.

Applications submitted electronically may be submitted in one of the
following formats:

1.  Microsoft Word

2.  PDF (Adobe Acrobat)

The preferred version is Microsoft Word 97; however, all versions must
have text search capability.

After notifying Reading Excellence staff, applications may also be
submitted in Corel WordPerfect format. Documents in Macintosh format
will not be accepted.

The electronic version will be the official file copy. The e-mailed
return receipt will be considered proof of receipt. The Department will
return a printed version to the applicant, upon request. Applicants that
submit an application electronically are requested to mail an unbound
hard copy to ensure that the complete application was accurately
transferred

While most of the application may be sent electronically, some parts
must be sent in hard copy -- forms which require original signatures.
The following forms, with original signatures, must be mailed to the
Department by the closing date:

1.  Cover page (SF 424)

2.  Assurances and Certifications

    a.  Assurances---Non-Construction Programs

    b.  Certifications regarding Lobbying; Debarment; Suspension and
        Other Responsibility Matter; and Drug-Free Workplace
        Requirements

    c.  Certification Regarding Debarment, Suspension, Ineligibility &
        Voluntary Exclusion -- Lower Tier Covered Transaction (if
        applicable)

    d.  Disclosure of Lobbying Activity (if applicable)

Original forms must show proof of mailing consisting of one of the
following:

-   A legible dated U.S. Postal Service Postmark;

-   A legible mail receipt with the date of mailing stamped by the U.S.
    Postal Service;

-   A dated shipping label, invoice, or receipt from a commercial
    carrier; or

-   Any other proof of mailing acceptable to the U.S. Secretary of
    Education.

An applicant should note that the U.S. Postal Service does not uniformly
provide a dated postmark. Before relying on this method, an applicant
should check with its local post office.

An applicant is encouraged to use registered or at least first-class
mail.

## Applications Sent by Mail Only

Two copies must accompany an application sent by mail, one of which must
be unbound (including all appendices). Applicants who choose to submit
hard copy applications must have an electronic version available upon
request. Hard copy applications must be mailed to: The U.S. Department
of Education, Application Control Center, Attention: CFDA 84.338A, 400
Maryland Avenue, SW, Washington, DC 20202-4725. An application must show
proof of mailing as follows.

Original forms must show proof of mailing consisting of one of the
following:

-   A legible dated U.S. Postal Service Postmark;

-   A legible mail receipt with the date of mailing stamped by the U.S.
    Postal Service;

-   A dated shipping label, invoice, or receipt from a commercial
    carrier; or

-   Any other proof of mailing acceptable to the U.S. Secretary of
    Education.

If the documents are sent through the U.S. Postal Service, the Secretary
does not accept either of the following as proof of mailing:

-   A private metered postmark, or

-   A mail receipt that is not dated by the U.S. Postal Service.

An applicant should note that the U.S. Postal Service does not uniformly
provide a dated postmark. Before relying on this method, an applicant
should check with its local post office.

An applicant is encouraged to use registered or at least first-class
mail. Each late applicant will be notified that its application will not
be considered.

## Applications Delivered by Hand/Courier Service: 

An application that is hand delivered must be taken to the U.S.
Department of Education, Coordination and Control Branch Room 3633,
General Services Administration National Capital Region, 7^th^ and D
Streets, S.W., Washington, D.C. 20202-4725.

The Application Control Center will accept deliveries between 8:00 a.m.,
and 4:30 p.m. (Eastern standard time) daily, except Saturdays, Sundays,
and Federal holidays.

Individuals delivering applications must use the D Street Entrance.
Proper identification is necessary to enter the building.

In order for an application sent through a Courier Service to be
considered timely, the Courier Service must be in receipt of the
application on or before the closing date.

# Instructions for Preparing the Application - Overview

This application contains the information and the required forms for you
to use in submitting a new application for funding. Applicants should
carefully review all the instructions in this application and the
selection criteria. *Applications are evaluated solely on the basis of
these criteria.* Experience shows that strong applications make a
reasoned and compelling case for the significance that research will
play in making a difference in classroom practice and in student
learning.

## Application Format and Length

**Narrative.** The narrative section of the application is limited to
the equivalent of no more than 100 single-spaced pages using the
following standards:

\(1\) A page is 8.5" x 11", on one side only.

\(2\) The page limit includes all narrative, titles, headings,
footnotes, quotations, references, and captions, as well as charts,
tables, figures and graphs.

\(3\) The font must be 11-point or larger.

\(4\) The page limit does not apply to the Application for Federal
Education Assistance Form (424); the Budget information Form (ED 524)
and attached itemization of costs; the other application checklists and
forms and attachments to those forms; the assurances and certifications;
or the Table of contents and the one-to-two page abstract which should
precede the narrative section and provide a short description of the
project.

All pages beyond the 100-page maximum will be removed unread and
returned to the applicant and will not be read by the reviewers
evaluating the application.

Bound copies of the application are not needed. The Department will make
copies for reviewers and for official files. We request that all
applicants send or bring one unbound copy of the application with no
tabs or inserts such as brochures. All sections of the application must
be suitable for photocopying. Applicants may use a binder clip or rubber
band to keep pages together.

If the applicant prefers to submit one or two bound copies in addition
to the unbound copy, that is acceptable but not necessary. If applicants
submit one or two bound copies, the REA program will use those as the
main file copy. All copies submitted must have original signatures.

**Appendices.** No more than two appendices may be included: one that
contains a description of any relevant State standards and assessments
and a second one (required) that lists local educational agencies and
schools eligible as of the date of the application and the number of
children and teachers in each school.

**Competitive priority.** When addressing the absolute priority, the
applicant should provide a brief assurance that the proposed project
will meet the above priority, and reflect this commitment in proposed
project activities throughout the application.

A table is included at page
[25](#checklist-for-teacher-certification-competitive-priority) that may
be used to address the competitive priority.

## Application Organization

It is recommended that the completed application be organized in the
following order and include the following parts*:*

A.  Cover page: Application for Federal Assistance (Standard Form 424).

B.  Table of contents

C.  Abstract: -- a one- to two-page brief description of the proposed
    project

D.  Program narrative (see page [17](#application-outline) and following
    for a suggested outline)

E.  Budget (ED form 524 and supporting information)

F.  Appendices

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1.  State standards and assessments related to reading

2.  List of eligible districts and schools

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G.  Assurances and other required information

```{=html}
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```
1.  Compliance with General Education Provisions Act (GEPA), Section 427

2.  Assurance Forms

    a.  *Non‑Construction Programs* (SF424B)

    b.  *Lobbying; Debarment; Suspension and Other Responsibility
        Matter; and Drug‑Free Workplace Requirements* (ED80‑0013)

    c.  If applicable: *Certification regarding debarment, suspension,
        ineligibility, and voluntary exclusion -- Lower tier covered
        transactions* (ED 80‑0014)

    d.  If applicable: *Disclosure of Lobbying activities* (Form LLL)

## Discretionary Grant Forms

Most of the following required Federal forms must be completed; included
in the application; and, except for the budget (Form 524), have an
original signature on at least one copy.

-   Form 424\--Application for Federal Education Assistance

-   ED Form 524\--Budget Information, Non-Construction Programs

-   Standard Form 424B\--Assurances, Non-Construction Programs

-   ED80-0013\--Certifications Regarding Lobbying; Debarment, Suspension
    and Other Responsibility Matters; and Drug-Free Workplace
    Requirements

-   ED80-0014\--Certification Regarding Debarment, Suspension,
    Ineligibility and Voluntary Exclusion \-- Lower Tier Covered
    Transactions (if applicable)

-   Standard Form LLL--Disclosure of Lobbying Activities (if applicable)

1.  Electronic versions of these forms and instructions can be accessed
    on the Internet at:

> <http://www.ed.gov/fund/grant/apply/appforms/appforms.html>

## Equitable Access and Participation - Section 427 of the General Education Provisions Act (GEPA)

The Department has guidance for grant applicants regarding the equitable
access and equitable participation provision in section 427 of GEPA.
Section 427 of GEPA requires all new applicants for Departmental
programs to describe in their applications the steps they propose to
take to ensure equitable access to, and equitable participation in the
project or activity to be conducted with program funds. The descriptions
should include the steps that the applicant intends to take to help
students, teachers and other beneficiaries overcome barriers to
equitable participation in program activities that the applicant would
conduct. The enclosure, NOTICE TO ALL APPLICANTS (OMB No. 1801-0004
(Exp. 3/31/2003), is included in this application.

**NO GRANT MAY BE AWARDED UNLESS A COMPLETE**

**APPLICATION HAS BEEN RECEIVED.**

# Selection Criteria

The following selection criteria will be used to evaluate applications
for new grants under this competition. The maximum score for all of
these criteria is 100 points. (An additional 5 points may be gained by
submitting information for the competitive priority for teacher
certification changes (see page
[16](#competitive-priority-on-teacher-certification-requirements)).)

The maximum score for each criterion is indicated in the parentheses.
There are no specific point totals for the subcategories within each
criterion.

**(1) Understanding and commitment to effective reading instruction
based on scientifically-based reading research. (15 points)**

> In determining the State\'s understanding and commitment to effective
> reading instruction based on scientifically-based reading research,
> the Secretary considers the following factors:

(a) The extent to which the proposed project incorporates a deep
    understanding of the scientifically- based reading research
    literature and how it applies in their State and local education
    systems.

> \(b\) The extent to which the scientific literature on reading is
> implemented in proposed grant activities.

**(2) Demonstration of need. (5 points)**

> In determining the need for the proposed project, the following
> factors are included: demographic and social data on the target
> population for this program (children and families) and State efforts
> and initiatives in reading, including current professional development
> activities related to the teaching of reading and family literacy,
> standards and assessments, and other related activities; and their
> relation, if any, to findings from scientifically-based reading
> research.

**(3) Quality of local district and school activities. (35 points)**

> In determining the quality of the services to be provided by local
> activities, the Secretary considers the following factors:
>
> \(a\) How the proposed project would change classroom instruction in
> schools under Local Reading Improvement subgrants. In particular, what
> professional development activities would be implemented.
>
> \(b\) The extent to which the proposed activities support
> research-based classroom reading instruction (including extended
> learning such as tutoring and summer programs, kindergarten
> transition, and family literacy/involvement).
>
> \(c\) The extent to which the proposed activities will improve reading
> instruction for all children, including English language learners,
> children with special needs, and children whose level of achievement
> indicates that they will need additional instructional support.
>
> \(d\) The extent to which the Tutorial Assistance subgrant activities
> of the proposed project reflect up-to-date knowledge of reading
> research and effective practice.

**(4) Quality of the plan for State leadership, oversight and
evaluation. (25 points)**

> In determining the quality of the plan for State leadership, oversight
> and evaluation, the Secretary considers the following factors:
>
> \(a\) The adequacy of procedures for ensuring success under this
> grant, including how the State will ensure that school activities will
> use practices based on scientifically-based reading research,
> especially professional development activities for K-3 teachers.
>
> \(b\) The adequacy of the management plan to achieve the objectives of
> the proposed project on time and within budget, including:

-   Development of the reading and literacy partnership for overseeing
    proposed grant activities;

-   Guidance provided to eligible districts and schools for developing
    applications;

-   Subgrant processes and criteria; and

-   Leadership, technical assistance, and monitoring activities for
    subgrantees that ensure continuous improvement in reading.

> \(c\) The qualifications, including relevant training and experience,
> of the key SEA staff responsible for managing the grant activities
> described above.
>
> \(d\) The quality of the State\'s evaluation design, including student
> outcome measures or indicators for grades K-3, subgrant (Local Reading
> Improvement and Tutorial Assistance) and school implementation
> measures and indicators, a timeline for data collection and reporting,
> provisions for feedback to districts, and identification of a
> qualified evaluator or inclusion of appropriate criteria.
>
> \(e\) The extent to which the proposed activities coordinate REA with
> other State initiatives and programs, including how the REA grant will
> add to current State and local efforts such as comprehensive early
> literacy programs.

**(5) Adequacy of resources. (15 points)**

> In determining the adequacy of resources, the Secretary considers the
> following factors:
>
> \(a\) The extent to which the average and range of amounts proposed,
> including the amounts per school, that will provide sufficient
> resources to accomplish the tasks of Local Reading Improvement and
> Tutorial Assistance subgrants.

\(b\) The budget provides sufficient detail and an appropriate level of
funding to accomplish the purposes of this grant.

# Regulatory Requirements

The Department published the following two priorities in the *Federal
Register* on April 18, 2000. The notice was on file as of April 13,
2000, and became official on that date. Definitions of the types of
priorities are as follows:

-   **Absolute priority:** Under an absolute priority we consider only
    applications that meet the priority (34 CFR 75.105(c)(3)).

-   **Competitive preference priority:** Under a competitive preference
    priority we give competitive preference to an application by
    awarding additional points, depending on how well the application
    meets the competitive priority (34 CFR 75.105(c)(2)(ii)).

## Absolute priority for focus on K-3 and related services and programs:

Under this priority, the Assistant Secretary gives an absolute
preference to SEAs that exclusively fund, at the subgrant level,
activities to improve kindergarten through grade three reading
instruction and related early childhood, professional development,
family literacy, extended learning and tutorial activities.

## Competitive priority on teacher certification requirements

Section 2253(c)(2)(C) of the Reading Excellence Act requires that
priority be given to SEAs whose States have modified, are modifying, or
provide an assurance that they will modify their elementary school
teacher certification requirements within 18 months after receiving an
REA grant. The modification must increase the training and the methods
of teaching reading required for certification as an elementary school
teacher to reflect scientifically-based reading research. However,
nothing in the REA shall be construed to establish a national system of
teacher certification.

The expert panel will award up to 5 additional points to applicants that
meet this priority. Two points will be awarded to applicants that
provide an assurance only. To receive the additional three points, the
SEA must include detailed plans or have implemented changes that
describe high quality teacher preparation that reflects
scientifically-based reading research.

# Application Outline

The following suggested outline for the application is consistent with
the selection criteria. Applicants may follow this outline or develop
one that provides similar information.

Table of contents

Abstract

1.  Introduction

2.  Need

    A.  Need for program in state (children and families, teaching
        staff, state and district systems)

    B.  Understanding of scientifically based reading research (SBRR)
        and high quality professional development

    C.  Current state efforts in reading, family literacy, standards and
        assessments, and school reform and how relates to SBRR

3.  State leadership and oversight

    A.  Reading and Literacy Partnership

        1.  Composition of partnership (positions, names, affiliations)

        2.  Role of partnership in development of this application

    B.  SEA activities under REA

        1.  Chart: Timeline, key activities, staff involved

        2.  How the state will use REA funds to design and implement
            high quality professional development for teachers, ensuring
            that it is based on scientifically based reading research,
            and integrate it into other efforts at the state and local
            levels.

        3.  Application process

            a.  Technical assistance and training for eligible districts
                and schools

            b.  Overview of application(s) for LRIs and Tutorials

            c.  Scoring and criteria

            d.  How will LEAs select schools?

            e.  Review process, including role of Reading and Literacy
                Partnership

        4.  Technical assistance (SEA-provided or SEA-organized),
            monitoring, and performance measurement to ensure high
            quality implementation and fidelity to SBRR by subgrantees

        5.  Other

            a.  Use of technology to facilitate program management,
                oversight, and professional development

            b.  Teacher certification reform

            c.  Tutorial Assistance program notification process

    C.  Staffing \-- SEA and other state-level or regional staff,
        consultants and organizations

        1.  Staff roles and responsibilities, time commitment

        2.  Resumes of key staff

4.  Local district/school interventions under Local Reading Improvement
    subgrants

    A.  Overview: How will classroom instruction change in your state\'s
        schools and what do you expect districts and schools to do to
        achieve this? What data will be available that reflect changes
        in classroom instruction?

    B.  Reading instruction:

        1.  Professional development and materials for Grade K-3

        2.  Instruction for English language learners

        3.  Instruction for children at risk of being referred
            inappropriately to special education

        4.  Teacher assessments to inform instruction

    C.  Supporting activities

        1.  Extended learning (tutoring and summer programs)

        2.  Kindergarten transition

        3.  Family literacy - coordination, expected services and age
            ranges

        4.  If applicable, use of technology to support local
            professional development or instruction.

        5.  Coordination with related programs

5.  Local district activities under Tutorial Assistance subgrants

    A.  Overview: What is expected of LEAs?

    B.  Criteria for determining eligibility of tutorial assistance
        providers

    C.  Organizing multiple providers and monitoring their services

    D.  Process for selecting children

    E.  Keeping parents informed

    F.  Ensuring participant confidentiality and privacy for families

    G.  Oversight and monitoring/administration

6.  Evaluation and performance measurement, planned contract

    A.  Evaluation design for outcomes and implementation evaluation

        1.  Student assessment measures, indicators, and other measures
            planned for grades K-3

        2.  Family literacy measures

        3.  Implementation measures, especially on professional
            development and classroom change

    B.  Timeline for data collection

    C.  Name and organization of evaluator or criteria for selection of
        the evaluator

    D.  Role of Reading and Literacy Partnership

7.  Relationship of REA activities to other state efforts

    A.  How does the state\'s REA program relate to other state efforts
        to improve reading?

    B.  What will REA add to current state efforts? What is the value
        added by REA?

8.  Budget (form plus detailed description)

    A.  Budget and details

    B.  Resources per school

        1.  Number of districts, schools, teachers, and children
            expected to be funded

        2.  Estimated average cost and range for districts and schools

            Appendix A: State standards and assessments related to
            reading

            Appendix B: List of eligible districts and eligible schools
            located in the district and the number of teachers and
            children in each school

            Description of compliance with GEPA Section 427

            Forms

# Supplemental Budget Form

Submission of this form will help to ensure that the state's funding
request complies fully with the Reading Excellence Act requirements.

+-------------+--------+---+--------+---+---------+---+--------+---+
| **Budget    | **Year |   | **Year |   | **Year  |   | **T    |   |
| breakdown** | 1**    |   | 2**    |   | 3**     |   | otal** |   |
+-------------+--------+---+--------+---+---------+---+--------+---+
|             | **     | * | **     | * | *       | * | **     | * |
|             | Dollar | * | Dollar | * | *Dollar | * | Dollar | * |
|             | Am     | % | Am     | % | A       | % | Am     | % |
|             | ount** | * | ount** | * | mount** | * | ount** | * |
|             |        | * |        | * |         | * |        | * |
+-------------+--------+---+--------+---+---------+---+--------+---+
| **State     |        |   |        |   |         |   |        |   |
| adm         |        |   |        |   |         |   |        |   |
| inistration |        |   |        |   |         |   |        |   |
| (up to      |        |   |        |   |         |   |        |   |
| 5%)**       |        |   |        |   |         |   |        |   |
+-------------+--------+---+--------+---+---------+---+--------+---+
| **State     |        |   |        |   |         |   |        |   |
| adm         |        |   |        |   |         |   |        |   |
| inistration |        |   |        |   |         |   |        |   |
| of Local    |        |   |        |   |         |   |        |   |
| Reading     |        |   |        |   |         |   |        |   |
| Improvement |        |   |        |   |         |   |        |   |
| subgrants** |        |   |        |   |         |   |        |   |
+-------------+--------+---+--------+---+---------+---+--------+---+
| *           |        |   |        |   |         |   |        |   |
| *Evaluation |        |   |        |   |         |   |        |   |
| (no more    |        |   |        |   |         |   |        |   |
| than 2%)**  |        |   |        |   |         |   |        |   |
+-------------+--------+---+--------+---+---------+---+--------+---+
| **Subtotal, |        |   |        |   |         |   |        |   |
| State       |        |   |        |   |         |   |        |   |
| admin       |        |   |        |   |         |   |        |   |
| istration** |        |   |        |   |         |   |        |   |
+-------------+--------+---+--------+---+---------+---+--------+---+
| **Local     |        |   |        |   |         |   |        |   |
| Reading     |        |   |        |   |         |   |        |   |
| Improvement |        |   |        |   |         |   |        |   |
| Subgrants   |        |   |        |   |         |   |        |   |
| (at least   |        |   |        |   |         |   |        |   |
| 80%)**      |        |   |        |   |         |   |        |   |
+-------------+--------+---+--------+---+---------+---+--------+---+
| **Subgrants |        |   |        |   |         |   |        |   |
| to LEAs**   |        |   |        |   |         |   |        |   |
+-------------+--------+---+--------+---+---------+---+--------+---+
| **Tutorial  |        |   |        |   |         |   |        |   |
| Assistance  |        |   |        |   |         |   |        |   |
| Subgrants   |        |   |        |   |         |   |        |   |
| (no more    |        |   |        |   |         |   |        |   |
| than 15%)** |        |   |        |   |         |   |        |   |
+-------------+--------+---+--------+---+---------+---+--------+---+
| **Subgrants |        |   |        |   |         |   |        |   |
| to LEAs**   |        |   |        |   |         |   |        |   |
+-------------+--------+---+--------+---+---------+---+--------+---+
| **State     |        |   |        |   |         |   |        |   |
| admin       |        |   |        |   |         |   |        |   |
| istration** |        |   |        |   |         |   |        |   |
+-------------+--------+---+--------+---+---------+---+--------+---+
| **Subtotal, |        |   |        |   |         |   |        |   |
| Tutorial    |        |   |        |   |         |   |        |   |
| A           |        |   |        |   |         |   |        |   |
| ssistance** |        |   |        |   |         |   |        |   |
+-------------+--------+---+--------+---+---------+---+--------+---+
| **Total,    |        |   |        |   |         |   |        |   |
| REA         |        |   |        |   |         |   |        |   |
| request**   |        |   |        |   |         |   |        |   |
+-------------+--------+---+--------+---+---------+---+--------+---+
| > **Total** |        |   |        |   |         |   |        |   |
+-------------+--------+---+--------+---+---------+---+--------+---+

**Comments:**

**State administration of Local Reading Improvement subgrants and
overall evaluation:** A state may reserve no more than 5 percent of its
REA grant funds for (1) costs of state administration of the Section
2255 Local Reading Improvement subgrants and (2) evaluation of both
programs.

-   Each SEA may use no more than 2 percent of the 5 percent to carry
    out evaluation and performance reporting required by section 2259.

-   Evaluation and reporting activities must cover both the Local
    Reading Improvement subgrants and the Tutorial Assistance subgrants.

**Local Reading Improvement subgrants:** At least 80 percent of the
state\'s grant must be used for Local Reading Improvement subgrants to
local educational agencies.

**Tutorial Assistance subgrants:** States may reserve up to 15 percent
for the Tutorial Assistance subgrant program (Section 2256) and should
charge administrative costs for the Tutorial Assistance subgrants --
soliciting applications, making awards, and overseeing the performance
of the subgrants -- to the 15 percent as well. States must plan to make
at least one Tutorial Assistance subgrant.

# Application Checklists

Following are checklists that applicants may use to make sure that they
have addressed all legislative requirements in the Reading Excellence
Act. These checklists include:

-   Reading Excellence Act legislative requirements for the application

-   General Education Provisions Act forms required

-   Reading and Literacy Partnership

-   Teacher certification

## Legislative Compliance Checklist

+---------------+----------------------------------------------+-------+
| **Reading     |                                              |       |
| Excellence    |                                              |       |
| Act           |                                              |       |
| Application   |                                              |       |
| R             |                                              |       |
| equirements** |                                              |       |
+===============+==============================================+=======+
| **Area**      | **Information to be Included**               | **I   |
|               |                                              | nclud |
|               |                                              | ed?** |
+---------------+----------------------------------------------+-------+
| Sec.          | The application must contain an assurance    |       |
| 2253(b)(2)(A) | that the Governor of the State, in           |       |
|               | consultation with the State educational      |       |
|               | agency, has established the required reading |       |
|               | and literacy partnership. The application    |       |
|               | must also include a description of how such  |       |
|               | partnership                                  |       |
|               |                                              |       |
|               | i.  assisted in the development of the State |       |
|               |     plan;                                    |       |
|               |                                              |       |
|               | ii. will be involved in advising on the      |       |
|               |     selection of Local Reading Improvement   |       |
|               |     and Tutorial Assistance; and             |       |
|               |                                              |       |
|               | iii. will assist in the oversight and        |       |
|               |      evaluation of the subgrantees           |       |
+---------------+----------------------------------------------+-------+
| Sec.          | Each application must contain a description  |       |
| 2253(b)(2)(B) | of the following:                            |       |
|               |                                              |       |
|               | i.  How the State educational agency will    |       |
|               |     ensure that professional development     |       |
|               |     activities related to reading            |       |
|               |     instruction and provided under this part |       |
|               |     are (a) coordinated with other State and |       |
|               |     local level funds and used effectively   |       |
|               |     to improve instructional practices for   |       |
|               |     reading and (b) based on scientifically  |       |
|               |     based reading research.                  |       |
|               |                                              |       |
|               | ii. How the activities assisted under this   |       |
|               |     part will address the needs of teachers  |       |
|               |     and other instructional staff, and will  |       |
|               |     effectively teach students to read.      |       |
|               |                                              |       |
|               | iii. The extent to which the activities will |       |
|               |      prepare teachers in all the major       |       |
|               |      components of reading instruction       |       |
|               |      (including phonemic awareness,          |       |
|               |      systematic phonics, fluency, and        |       |
|               |      reading comprehension)                  |       |
|               |                                              |       |
|               | iv. How the State educational agency will    |       |
|               |     use technology to enhance reading and    |       |
|               |     literacy professional development        |       |
|               |     activities for teachers, as appropriate. |       |
|               |                                              |       |
|               | v.  How parents can participate in           |       |
|               |     literacy-related activities assisted     |       |
|               |     under this part to enhance their         |       |
|               |     children's reading.                      |       |
|               |                                              |       |
|               | vi. How subgrants made by the State          |       |
|               |     educational agency will meet the         |       |
|               |     requirement of the law, including how    |       |
|               |     the State educational agency will ensure |       |
|               |     that subgrantees will use practices      |       |
|               |     based on scientifically based reading    |       |
|               |     research.                                |       |
|               |                                              |       |
|               | vii. How the State educational agency will,  |       |
|               |      to the extent practicable, make grants  |       |
|               |      to subgrantees in both rural and urban  |       |
|               |      areas.                                  |       |
|               |                                              |       |
|               | viii. The process that the State used to     |       |
|               |       establish the required reading and     |       |
|               |       literacy partnership.                  |       |
+---------------+----------------------------------------------+-------+
| Sec.          | Each application must contain an assurance   |       |
| 2253(b)(2)(C) | that each local educational agency to which  |       |
|               | the State educational agency makes a         |       |
|               | subgrant---                                  |       |
|               |                                              |       |
|               | i.  Will provide professional development    |       |
|               |     for the classroom teacher and other      |       |
|               |     appropriate instructional staff on the   |       |
|               |     teaching of reading based on             |       |
|               |     scientifically based reading research.   |       |
|               |                                              |       |
|               | ii. Will provide family literacy services    |       |
|               |     based on programs such as the Even Start |       |
|               |     family literacy model authorized under   |       |
|               |     part B of title I, to enable parents to  |       |
|               |     be their child's first and most          |       |
|               |     important teacher.                       |       |
|               |                                              |       |
|               | iii. Will carry out programs to assist those |       |
|               |      kindergarten students who are not ready |       |
|               |      for the transition to first grade,      |       |
|               |      particularly students experiencing      |       |
|               |      difficulty with reading skills; and     |       |
|               |                                              |       |
|               | iv. will use supervised individuals          |       |
|               |     (including tutors), who have been        |       |
|               |     appropriately trained using              |       |
|               |     scientifically based reading research,   |       |
|               |     to provide additional support, before    |       |
|               |     school, after school, on weekends,       |       |
|               |     during noninstructional periods of the   |       |
|               |     school day, or during the summer, for    |       |
|               |     children preparing to enter kindergarten |       |
|               |     and students in kindergarten through     |       |
|               |     grade 3 who are experiencing difficulty  |       |
|               |     reading.                                 |       |
+---------------+----------------------------------------------+-------+
| Sec.          | Each application must contain an assurance   |       |
| 2253(b)(2)(D) | that instruction in reading will be provided |       |
|               | to children with reading difficulties who--- |       |
|               |                                              |       |
|               | i.  Are at risk of being referred to special |       |
|               |     education based on these difficulties;   |       |
|               |     or                                       |       |
|               |                                              |       |
|               | ii. Have been evaluated under section 614 of |       |
|               |     the Individuals with Disabilities        |       |
|               |     Education Act but, in accordance with    |       |
|               |     section 614(b)(5) of such Act, have not  |       |
|               |     been identified as being a child with a  |       |
|               |     disability (as defined in section 602 of |       |
|               |     the such Act).                           |       |
+---------------+----------------------------------------------+-------+
| Sec.          | Each application must contain a description  |       |
| 2253(b)(2)(E) | of how the State educational agency will     |       |
|               |                                              |       |
|               | i.  build on, and promote coordination       |       |
|               |     among, literacy programs in the State    |       |
|               |     (including federally funded programs     |       |
|               |     such as the Adult Education and Family   |       |
|               |     Literacy Act and the Individuals with    |       |
|               |     Disabilities Education Act), in order to |       |
|               |     increase\--the effectiveness of the      |       |
|               |     programs in improving reading for adults |       |
|               |     and children and to avoid duplication of |       |
|               |     the efforts of the programs;             |       |
|               |                                              |       |
|               | ii. Will promote reading and library         |       |
|               |     programs that provide access to engaging |       |
|               |     reading material;                        |       |
|               |                                              |       |
|               | iii. Will make eligible local educational    |       |
|               |      agencies aware of the availability of   |       |
|               |      Local Reading Improvement and Tutorial  |       |
|               |      Assistance Subgrants; and               |       |
|               |                                              |       |
|               | iv. Will assess and evaluate, on a regular   |       |
|               |     basis, local educational agency          |       |
|               |     activities supported by the Reading      |       |
|               |     Excellence Act.                          |       |
+---------------+----------------------------------------------+-------+
| Sec.          | Each application must contain a description  |       |
| 2253(b)(2)(F) | of the evaluation instrument the State       |       |
|               | educational agency will use for the required |       |
|               | evaluation of the program.                   |       |
+---------------+----------------------------------------------+-------+

## Requirements from GEPA and Other General Education Legislation and Regulations

All forms below, with the exception of the budget form and GEPA Section
427 (which is a narrative statement), must be submitted in hard copy
with an original signature. The budget and statement on compliance with
GEPA 427 must be included in the application.

  -----------------------------------------------------------------------------------
  **Area**       **Information to be Included**         **Signed?**   **Included?**
  -------------- -------------------------------------- ------------- ---------------
  Cover page     SF 424: Application for Federal                      
                 Education Assistance                                 

  Budget form    ED Form 524: Itemized budget & other                 
                 budget information                                   

  General        Description of compliance with the                   
  Education      General Education Provisions Act,                    
  Provisions Act Section 427                                          
  (GEPA)                                                              

  GEPA           Assurance: Non-Construction Programs                 
                 (SF424B)                                             

  GEPA           Certifications: Lobbying; Debarment;                 
                 Suspension and Other Responsibility                  
                 Matter; and Drug-Free Workplace                      
                 Requirements (ED80-0013)                             

  GEPA           If applicable: Certification Regarding               
                 Debarment, Suspension, Ineligibility,                
                 and Voluntary Exclusion------ Lower                  
                 Tier Covered Transactions (ED 80-0014)               

  GEPA           If applicable: Disclosure of Lobbying                
                 Activities (Form LLL)                                
  -----------------------------------------------------------------------------------

##  Checklist for Reading and Literacy Partnership

+---+------------------------------------------------------------+-----+
| * |                                                            |     |
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+---+------------------------------------------------------------+-----+
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+---+------------------------------------------------------------+-----+
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+---+------------------------------------------------------------+-----+
| * |                                                            | **D |
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+---+------------------------------------------------------------+-----+
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+---+------------------------------------------------------------+-----+
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+---+------------------------------------------------------------+-----+
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+---+------------------------------------------------------------+-----+
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| . |                                                            |     |
+---+------------------------------------------------------------+-----+
| L |                                                            |     |
| i |                                                            |     |
| s |                                                            |     |
| t |                                                            |     |
| o |                                                            |     |
| f |                                                            |     |
| m |                                                            |     |
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| m |                                                            |     |
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| m |                                                            |     |
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| o |                                                            |     |
| r |                                                            |     |
| n |                                                            |     |
| a |                                                            |     |
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| s |                                                            |     |
| a |                                                            |     |
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| d |                                                            |     |
| a |                                                            |     |
| f |                                                            |     |
| f |                                                            |     |
| i |                                                            |     |
| l |                                                            |     |
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| a |                                                            |     |
| t |                                                            |     |
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| n |                                                            |     |
| ) |                                                            |     |
| [ |                                                            |     |
| ^ |                                                            |     |
| 1 |                                                            |     |
| ] |                                                            |     |
+---+------------------------------------------------------------+-----+
|   | *For new partnership (not a pre-existing partnership):*    |     |
+---+------------------------------------------------------------+-----+
|   | -   Governor                                               |     |
+---+------------------------------------------------------------+-----+
|   | -   Chief State School Officer                             |     |
+---+------------------------------------------------------------+-----+
|   | -   The chairman and the ranking member of each committee  |     |
|   |     of the state legislature that is responsible for       |     |
|   |     education policy                                       |     |
+---+------------------------------------------------------------+-----+
|   | -   A representative, selected jointly by the Governor and |     |
|   |     Chief State school officer, of at least one local      |     |
|   |     educational agency that is eligible to receive an LRI  |     |
|   |     subgrant                                               |     |
+---+------------------------------------------------------------+-----+
|   | -   A representative, selected jointly by the Governor and |     |
|   |     Chief State school officer, of a community-based       |     |
|   |     organization working with children to improve their    |     |
|   |     reading skills                                         |     |
+---+------------------------------------------------------------+-----+
|   | -   State directors of appropriate Federal or State        |     |
|   |     programs with strong reading component                 |     |
+---+------------------------------------------------------------+-----+
|   | -   A parent of a public or private schools student or a   |     |
|   |     parent who educates their child or children in their   |     |
|   |     home selected jointly by the Governor and Chief State  |     |
|   |     school officer                                         |     |
+---+------------------------------------------------------------+-----+
|   | -   A teacher who successfully teaches reading selected    |     |
|   |     jointly by the Governor and Chief State school officer |     |
|   |     and an instructional staff member selected jointly by  |     |
|   |     the Governor and Chief State school officer            |     |
+---+------------------------------------------------------------+-----+
|   | -   A family literacy provider selected jointly by the     |     |
|   |     Governor and Chief State school officer                |     |
+---+------------------------------------------------------------+-----+
|   | *For REA partnership based on pre-existing partnership:*   |     |
+---+------------------------------------------------------------+-----+
|   | -   Governor                                               |     |
+---+------------------------------------------------------------+-----+
|   | -   Chief State School Officer                             |     |
+---+------------------------------------------------------------+-----+
|   | -   ??                                                     |     |
+---+------------------------------------------------------------+-----+
|   | -   ??                                                     |     |
+---+------------------------------------------------------------+-----+

## Checklist for Teacher Certification (competitive priority)

> "(C) PRIORITY.---The panel shall recommend grant applications from
> State educational agencies under this section to the Secretary for
> funding or for disapproval. In making such recommendations, the panel
> shall give priority to applications from State educational agencies
> whose States have modified, are modifying, or provide an assurance
> that not later than 18 months after receiving a grant under this
> section the State educational agencies will increase the training and
> the methods of teaching reading required for certification as an
> elementary school teacher to reflect scientifically based reading
> research, except that nothing in this Act shall be construed to
> establish a national system of teacher certification." Section
> 2253(c)(2)(C)

+---+------------------------------------------------------------------+
| * |                                                                  |
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| d |                                                                  |
| y |                                                                  |
| : |                                                                  |
| * |                                                                  |
| * |                                                                  |
+---+------------------------------------------------------------------+
|   | Has the state modified elementary school teacher certification   |
|   | requirements? \_\_\_\_ Yes \_\_\_\_ No                           |
+---+------------------------------------------------------------------+
|   | When were they modified?                                         |
|   |                                                                  |
|   | Month: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Year: 19\_\_\_\_   |
+---+------------------------------------------------------------------+
|   | Did the modification increase requirements in the area of        |
|   | reading covering grades K-3?                                     |
|   |                                                                  |
|   | \_\_\_\_ Yes \_\_\_\_ No                                         |
+---+------------------------------------------------------------------+
|   | What were the changes? How were the changes related to           |
|   | scientifically-based reading research?                           |
+---+------------------------------------------------------------------+
| * |                                                                  |
| * |                                                                  |
| T |                                                                  |
| e |                                                                  |
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| i |                                                                  |
| c |                                                                  |
| a |                                                                  |
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| i |                                                                  |
| o |                                                                  |
| n |                                                                  |
| c |                                                                  |
| h |                                                                  |
| a |                                                                  |
| n |                                                                  |
| g |                                                                  |
| e |                                                                  |
| s |                                                                  |
| p |                                                                  |
| r |                                                                  |
| o |                                                                  |
| p |                                                                  |
| o |                                                                  |
| s |                                                                  |
| e |                                                                  |
| d |                                                                  |
| t |                                                                  |
| o |                                                                  |
| b |                                                                  |
| e |                                                                  |
| m |                                                                  |
| a |                                                                  |
| d |                                                                  |
| e |                                                                  |
| w |                                                                  |
| i |                                                                  |
| t |                                                                  |
| h |                                                                  |
| i |                                                                  |
| n |                                                                  |
| 1 |                                                                  |
| 8 |                                                                  |
| m |                                                                  |
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| n |                                                                  |
| t |                                                                  |
| h |                                                                  |
| s |                                                                  |
| a |                                                                  |
| f |                                                                  |
| t |                                                                  |
| e |                                                                  |
| r |                                                                  |
| t |                                                                  |
| h |                                                                  |
| e |                                                                  |
| s |                                                                  |
| t |                                                                  |
| a |                                                                  |
| r |                                                                  |
| t |                                                                  |
| o |                                                                  |
| f |                                                                  |
| t |                                                                  |
| h |                                                                  |
| e |                                                                  |
| g |                                                                  |
| r |                                                                  |
| a |                                                                  |
| n |                                                                  |
| t |                                                                  |
| : |                                                                  |
| * |                                                                  |
| * |                                                                  |
+---+------------------------------------------------------------------+
|   | Does the state promise to make changes in elementary teacher     |
|   | certification requirements?                                      |
|   |                                                                  |
|   | \_\_\_\_\_ Yes \_\_\_\_\_ No (skip to item 8)                    |
+---+------------------------------------------------------------------+
|   | When does the state plan to make these changes?                  |
+---+------------------------------------------------------------------+
|   | What changes are proposed? How are the changes related to        |
|   | scientifically-based reading research?                           |
+---+------------------------------------------------------------------+

# Guidance on Section 427 of the General Education Provision Act

> **Notice To All Applicants**

The purpose of this enclosure is to inform you about a provision in the
Department of Education\'s General Education Provisions Act (GEPA) that
applies to applicants for new grant awards under Department programs.
This provision is Section 427 of GEPA, enacted as part of the Improving
America\'s Schools Act of 1994 (Pub. L. 103-382).

***To whom does this provision apply?***

Section 427 of GEPA affects applicants for new grant awards under this
program. All applicants for new awards must include information in their
applications to address this provision in order to receive funding under
this program.

***What does this provision require?***

Section 427 requires each applicant for funds (other than an individual
person) to include in its application a description of the steps the
applicant proposes to take to ensure equitable access to, and
participation in its Federally-assisted program for students, teachers,
and other program beneficiaries with special needs.

This provision allows applicants discretion in developing the required
description. The statute highlights six types of barriers that can
impede equitable access or participation: gender, race, national origin,
color, disability, or age. Based on local circumstances, you should
determine whether these or other barriers may prevent your students,
teachers, etc. from such access or participation in, the
Federally-funded project or activity. The description in your
application of steps to be taken to overcome these barriers need not be
lengthy; you may provide a clear and succinct description of how you
plan to address those barriers that are applicable to your
circumstances. In addition, the information may be provided in a single
narrative, or, if appropriate, may be discussed in connection with
related topics in the application.

Section 427 is not intended to duplicate the requirements of civil
rights statutes, but rather to ensure that, in designing their projects,
applicants for Federal funds address equity concerns that may affect the
ability of certain potential beneficiaries to fully participate in the
project and to achieve to high standards. Consistent with program
requirements and its approved application, an applicant may use the
Federal funds awarded to it to eliminate barriers it identifies.

***What are examples of how an applicant might satisfy the requirement
of this provision?***

The following examples may help illustrate how an applicant may comply
with Section 427.

\(1\) An applicant that proposes to carry out an adult literacy project
serving, among others, adults with limited English proficiency, might
describe in its application how it intends to distribute a brochure
about the proposed project to such potential participants in their
native language.

\(2\) An applicant that proposes to develop instructional materials for
classroom use might describe how it will make the materials available on
audio tape or in Braille for students who are blind.

\(3\) An applicant that proposes to carry out a model science program
for secondary students and is concerned that girls may be less likely
than boys to enroll in the course, might indicate how it intends to
conduct \"outreach\" efforts to girls, to encourage their enrollment.

We recognize that many applicants may already be implementing effective
steps to ensure equity of access and participation in their grant
programs, and we appreciate your cooperation in responding to the
requirements of this provision.

+-----------------------------------------------------------------------+
| **Estimated Burden Statement for GEPA Requirements**                  |
|                                                                       |
| The time required to complete this information collection is          |
| estimated to vary from 1 to 3 hours per response, with an average of  |
| 1.5 hours, including the time to review instructions, search existing |
| data resources, gather and maintain the data needed, and complete and |
| review the information collection.                                    |
|                                                                       |
| If you have any comments concerning the accuracy of the time          |
| estimate(s) or suggestions for improving this form, please write to:  |
| U.S. Department of Education, Washington, DC 20202-4651.              |
+-----------------------------------------------------------------------+

**OMB Control No. 1801-0004 (Exp. 3/31/2003)**

# Standard Forms for Discretionary Grant Applications

Except for the budget (Section 524), if submitted, the following forms
must be submitted in hard copy to the Department with original
signatures.

-   Application for Federal Assistance, U.S. Department of Education (ED
    form 424)

```{=html}
<!-- -->
```
-   Instructions for filling out ED form 424

```{=html}
<!-- -->
```
-   Protection of Human Subjects in Research (attachment to ED 424)

```{=html}
<!-- -->
```
-   ED Form 524\--Budget Information, Non-Construction Programs

```{=html}
<!-- -->
```
-   ED Form 524\--Instructions

```{=html}
<!-- -->
```
-   Standard Form 424B--Assurances, Non-Construction Programs

-   D80-0013\--Certifications Regarding Lobbying; Debarment, Suspension
    and Other Responsibility Matters; and Drug-Free Workplace
    Requirements

-   ED80-0014\--Certification Regarding Debarment, Suspension,
    Ineligibility and Voluntary Exclusion--Lower Tier Covered
    Transactions (if applicable)

-   Standard Form LLL--Disclosure of Lobbying Activities (if applicable)

Electronic version of these forms and instructions in Adobe .PDF,
Microsoft Word, and Corel WordPerfect formats are available at::

> <http://www.ed.gov/fund/grant/apply/appforms/appforms.html>

![](media/image3.wmf) **U.S. Department of Education**

**Education Assistance**

**Applicant Information**

**1.** Name and Address Organizational Unit

Legal
Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_ - \_\_\_\_\_\_\_\_\_

City State County ZIP Code + 4

**2.** Applicant's D-U-N-S Number:
\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|
**6.** Is the applicant delinquent on any Federal debt? \_\_\_Yes
\_\_\_\_No

> *(If "Yes," attach an explanation.)*

**3.** Applicant's T-I-N \|\_\_\_\|\_\_\_\| -
\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|

Title:**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**4.** Catalog of Federal Domestic Assistance #: **84.338** 
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**5.** Project
Director:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**7.** Type of Applicant *(Enter appropriate letter in the box.)
\|\_\_\_\_\_\_\|*

Address:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_

City State Zip code + 4

Tel. #: ( ) \_\_\_\_\_\_\_-\_\_\_\_\_\_\_\_ Fax #: (
)\_\_\_\_\_\_\_-\_\_\_\_\_\_\_\_

E-Mail
Address:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> **8.** Novice Applicant \_\_\_Yes \_\_\_\_ No

**Application Information**

**9.** Type of Submission: **12.** Are any research activities involving
human subjects planned at

*-PreApplication -Application* any time during the proposed project
period? \_\_\_\_Yes \_\_\_\_\_No

\_\_\_\_Construction \_\_\_\_Construction a. If "Yes," Exemption(s) #:
b. Assurance of Compliance #:

\_\_\_\_Non-Construction \_\_\_\_Non-Construction

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ***OR***
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**10.** Is application subject to review by Executive Order 12372
process?

\_\_\_\_ Yes (*Date made available to the Executive Order 12372* c. IRB
approval date: \_\_\_\_ Full IRB **[or]{.underline}**

*process for review):* \_\_\_\_/\_\_\_\_/\_\_\_\_\_\_\_\_\_
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_** Expedited Review

\_\_\_\_ No *(If "No," check appropriate box below.)*

\_\_\_\_ Program is not covered by E.O. 12372.

\_\_\_\_ Program has not been selected by State for review.

**11.** Proposed Project Dates: \_\_\_\_/\_\_\_\_/\_\_\_\_\_\_\_\_
\_\_\_\_/\_\_\_\_/\_\_\_\_\_\_\_\_\_

> **Start Date: End Date:**

+-----------------------------+----------------------------------------+
| **Estimated Funding**       | **Authorized Representative            |
|                             | Information**                          |
| **14 a.** Federal **\$      |                                        |
| \_\_\_                      | **15.** To the best of my knowledge    |
| \_\_\_\_\_\_\_\_\_\_\_\_\_. | and belief, all data in this           |
| 00**                        | preapplication/application are true    |
|                             | and correct. The document has been     |
| **b.** Applicant \$         | duly authorized by the governing body  |
| **\_\_\_                    | of the applicant and the applicant     |
| \_\_\_\_\_\_\_\_\_\_\_\_\_. | will comply with the attached          |
| 00**                        | assurances if the assistance is        |
|                             | awarded.                               |
| **c.** State **\$           |                                        |
| \_\_\_                      | **a.** Typed Name of Authorized        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_. | Representative:                        |
| 00**                        |                                        |
|                             | **b.** Title:                          |
| **d.** Local \$             |                                        |
| **\_\_\_                    | **c.** Tel. #: ( )                     |
| \_\_\_\_\_\_\_\_\_\_\_\_\_. | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Fax #:  |
| 00**                        | ( ) \_\_\_\_\_\_\_\_\_\_\_\_\_\_       |
|                             |                                        |
| **e.** Other **\$           | **d.** E-mail Address:                 |
| \_\_\_                      |                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_. | **e. Signature of Authorized           |
| 00**                        | Representative**                       |
|                             |                                        |
| **f.** Program Income **\$  | Date: \_\_\_\_/\_\_\_\_/\_\_\_\_\_\_   |
| \_\_\_                      |                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_. |                                        |
| 00**                        |                                        |
|                             |                                        |
| **g. TOTAL \$               |                                        |
| \_\_\_                      |                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_. |                                        |
| 00**                        |                                        |
|                             |                                        |
| ED 424 (rev 11/12/99)       |                                        |
+-----------------------------+----------------------------------------+

> **Instructions for ED 424**
>
> **1.** **Legal Name and Address.** Enter the legal name of applicant
> and the name of the primary organizational unit which will undertake
> the assistance activity.
>
> **2.** **D-U-N-S Number.** Enter the applicant's D-U-N-S Number. If
> your organization does not have a D-U-N-S Number, you can obtain the
> number by calling 1-800-333-0505 or by completing a D-U-N-S Number
> Request Form. The form can be obtained via the Internet at the
> following URL: **http://www.dnb.com/.**
>
> **3. Tax Identification Number.** Enter the tax identification number
> as assigned by the Internal Revenue Service.
>
> **4.** **Catalog of Federal Domestic Assistance** **(CFDA) Number.**
> Enter the CFDA number and title of the program under which assistance
> is requested.
>
> **5.** **Project Director.** Name, address, telephone and fax numbers,
> and e-mail address of the person to be contacted on matters involving
> this application.
>
> **6.** **Federal Debt Delinquency.** Check **"Yes"** if the
> applicant's organization is delinquent on any Federal debt. (This
> question refers to the applicant's organization and not to the person
> who signs as the authorized representative. Categories of debt include
> delinquent audit disallowances, loans and taxes.) Otherwise, check
> **"No."**
>
> **7. Type of Applicant.** Enter the appropriate letter in the box
> provided.
>
> **8. Novice Applicant.** Check **"Yes"** only if assistance is being
> requested under a program that gives special consideration to novice
> applicants and you meet the program requirements for novice
> applicants. By checking "Yes" the applicant certifies that it meets
> the novice applicant requirements specified by ED. Otherwise, check
> **"No."**
>
> **9.** **Type of Submission.** Self-explanatory.
>
> **10.** **Executive Order 12372.** Check **"Yes"** if the application
> is subject to review by Executive Order 12372. Also, please enter the
> month, date, and four (4) digit year (e.g., 12/12/2000). Applicants
> should contact the State Single Point of Contact (SPOC) for Federal
> Executive Order 12372 to determine whether the application is subject
> to the State intergovernmental review process. Otherwise, check
> **"No."**

**11. Proposed Project Dates.** Please enter the month, date, and four
(4) digit year (e.g., 12/12/2000).

**12. Human Subjects.** Check "Yes" **[or]{.underline}** "No". If
research activities involving human subjects are **[not]{.underline}**
planned **[at any time]{.underline}** during the proposed project
period, check **"No."** **The remaining parts of item 11 are then not
applicable.**

If research activities involving human subjects, whether or not exempt
from Federal regulations for the protection of human subjects,
**[are]{.underline}** planned **[at any time]{.underline}** during the
proposed project period, either at the applicant organization or at any
other performance site or collaborating institution, check **"Yes."** If
**[all]{.underline}** the research activities are designated to be
exempt under the regulations, enter, in item 11a, the exemption
number(s) corresponding to one or more of the six exemption categories
listed in **"Protection of Human Subjects in Research"** attached to
this form. Provide sufficient information in the application to allow a
determination that the designated exemptions in item 11a, are
appropriate. **Provide this narrative information in an "Item
11/Protection of Human Subjects Attachment" and insert this attachment
immediately following the ED 424 face page. Skip the remaining parts of
item 11.**

If **[some or all]{.underline}** of the planned research activities
involving human subjects are covered (nonexempt), skip item 11a and
continue with the remaining parts of item 11, as noted below. In
addition, follow the instructions in **"Protection of Human Subjects in
Research"** attached to this form to prepare the six-point narrative
about the nonexempt activities. **Provide this six-point** **narrative
in an "Item 11/Protection of Human Subjects Attachment" and insert this
attachment immediately following the ED 424 face page.**

**If the applicant organization has an approved Multiple Project
Assurance of Compliance** on file with the Grants Policy and Oversight
Staff (GPOS), U.S. Department of Education, or with the Office for
Protection from Research Risks (OPRR), National Institutes of Health,
U.S. Department of Health and Human Services, that covers the specific
activity, enter the Assurance number in item 11b and the date of
approval by the Institutional Review Board (IRB) of the proposed
activities in item 11c. This date must be no earlier than one year
before the receipt date for which the application is submitted and must
include the four (4) digit year (e.g., 2000). Check the type of IRB
review in the appropriate box. An IRB may use the expedited review
procedure if it complies with the requirements of 34 CFR 97.110. If the
IRB review is delayed beyond the submission of the application, enter
**"Pending"** in item 11c. If your application is recommended/selected
for funding, a follow-up certification of IRB approval from an official
signing for the applicant organization must be sent to and received by
the designated ED official within 30 days after a specific formal
request from the designated ED official. **If the applicant organization
does not have** on file with GPOS or OPRR **an approved Assurance of
Compliance** that covers the proposed research activity, enter
**"None"** in item 11b and skip 11c. In this case, the applicant
organization, by the signature on the application, is declaring that it
will comply with 34 CFR 97 within 30 days after a specific formal
request from the designated ED official for the Assurance(s) and IRB
certifications.

**13. Project Title.** Enter a brief descriptive title of the project.
If more than one program is involved, you should append an explanation
on a separate sheet. If appropriate (e.g., construction or real property
projects), attach a map showing project location. For preapplications,
use a separate sheet to provide a summary description of this project.

**14. Estimated Funding.** Amount requested or to be contributed during
the first funding/budget period by each contributor. Value of in-kind
contributions should be included on appropriate lines as applicable. If
the action will result in a dollar change to an existing award, indicate
**[only]{.underline}** the amount of the change. For decreases, enclose
the amounts in parentheses. If both basic and supplemental amounts are
included, show breakdown on an attached sheet. For multiple program
funding, use totals and show breakdown using same categories as item 13.

**15. Certification.** To be signed by the authorized representative of
the applicant. A copy of the governing body's authorization for you to
sign this application as official representative must be on file in the
applicant's office.

Be sure to enter the telephone and fax number and e-mail address of the
authorized representative. Also, in item 14e, please enter the month,
date, and four (4) digit year (e.g., 12/12/2000) in the date signed
field.

**Paperwork Burden Statement**

> According to the Paperwork Reduction Act of 1995, no persons are
> required to respond to a collection of information unless such
> collection displays a valid OMB control number. The valid OMB control
> number for this information collection is **1875-0106**. The time
> required to complete this information collection is estimated to
> average between 15 and 45 minutes per response, including the time to
> review instructions, search existing data resources, gather the data
> needed, and complete and review the information collection. **If you
> have any comments concerning the accuracy of the estimate(s) or
> suggestions for improving this form, please write to:** U.S.
> Department of Education, Washington, D.C. 20202-4651. **If you have
> comments or concerns regarding the status of your individual
> submission of this form write directly to:** Joyce I. Mays,
> Application Control Center, U.S. Department of Education, 7th and D
> Streets, S.W. ROB-3, Room 3633, Washington, D.C. 20202-4725

**Protection of Human Subjects in Research**

**(Attachment to ED 424)**

**I. Instructions to Applicants about the Narrative Information that
Must be Provided if Research Activities Involving Human Subjects are
Planned.**

If you marked item 11 on the application "Yes" and designated exemptions
in 11a , **(all research activities are exempt),** provide sufficient
information in the application to allow a determination that the
designated exemptions are appropriate. Research involving human subjects
that is exempt from the regulations is discussed under **II.B.
"Exemptions,"** below. The Narrative must be succinct. **Provide this
information in an "Item 11/Protection of Human Subjects Attachment" and
insert this attachment immediately following the ED 424 face page.**

If you marked "Yes" to item 11 on the face page, and designated no
exemptions from the regulations **(some or all of the research
activities are nonexempt),** address the following six points for each
nonexempt activity. In addition, if research involving human subjects
will take place at collaborating site(s) or other performance site(s),
provide this information before discussing the six points. Although no
specific page limitation applies to this section of the application, be
succinct. Provide the six-point narrative and discussion of other
performance sites in an **"Item 11/Protection of Human Subjects
Attachment" and insert this attachment immediately following the ED 424
face page.**

\(1\) Provide a detailed description of the proposed involvement of
human subjects. Describe the characteristics of the subject population,
including their anticipated number, age range, and health status.
Identify the criteria for inclusion or exclusion of any subpopulation.
Explain the rationale for the involvement of special classes of
subjects, such as children, children with disabilities, adults with
disabilities, persons with mental disabilities, pregnant women,
prisoners, institutionalized individuals, or others who are likely to be
vulnerable.

\(2\) Identify the sources of research material obtained from
individually identifiable living human subjects in the form of
specimens, records, or data. Indicate whether the material or data will
be obtained specifically for research purposes or whether use will be
made of existing specimens, records, or data.

\(3\) Describe plans for the recruitment of subjects and the consent
procedures to be followed. Include the circumstances under which consent
will be sought and obtained, who will seek it, the nature of the
information to be provided to prospective subjects, and the method of
documenting consent. State if the Institutional Review Board (IRB) has
authorized a modification or waiver of the elements of consent or the
requirement for documentation of consent.

\(4\) Describe potential risks (physical, psychological, social, legal,
or other) and assess their likelihood and seriousness. Where
appropriate, describe alternative treatments and procedures that might
be advantageous to the subjects.

\(5\) Describe the procedures for protecting against or minimizing
potential risks, including risks to confidentiality, and assess their
likely effectiveness. Where appropriate, discuss provisions for ensuring
necessary medical or professional intervention in the event of adverse
effects to the subjects. Also, where appropriate, describe the
provisions for monitoring the data collected to ensure the safety of the
subjects.

\(6\) Discuss why the risks to subjects are reasonable in relation to
the anticipated benefits to subjects and in relation to the importance
of the knowledge that may reasonably be expected to result.

**II. Information on Research Activities**

**Involving Human Subjects**

**A. Definitions.**

A research activity involves human subjects if the activity is research,
as defined in the Department's regulations, and the research activity
will involve use of human subjects, as defined in the regulations.

**---Is it a research activity?**

The ED Regulations for the Protection of Human Subjects, Title 34, Code
of Federal Regulations, Part 97, define research as "a systematic
investigation, including research development, testing and evaluation,
designed to develop or contribute to generalizable knowledge." *If an
activity follows a deliberate plan whose purpose is to develop or
contribute to generalizable knowledge, such as an exploratory study or
the collection of data to test a hypothesis, it is research.* Activities
which meet this definition constitute research whether or not they are
conducted or supported under a program which is considered research for
other purposes. For example, some demonstration and service programs may
include research activities.

**---Is it a human subject?**

The regulations define human subject as "a living individual about whom
an investigator (whether professional or student) conducting research
obtains (1) data through intervention or interaction with the
individual, or (2) identifiable private information." *(1) If an
activity involves obtaining information about a living person by
manipulating that person or that person's environment, as might occur
when a new instructional technique is tested, or by communicating or
interacting with the individual, as occurs with surveys and interviews,
the definition of human subject is met. (2) If an activity involves
obtaining private information about a living person in such a way that
the information can be linked to that individual (the identity of the
subject is or may be readily determined by the investigator or
associated with the information), the definition of human subject is
met.* \[Private information includes information about behavior that
occurs in a context in which an individual can reasonably expect that no
observation or recording is taking place, and information which has been
provided for specific purposes by an individual and which the individual
can reasonably expect will not be made public (for example, a school
health record).\]

**B. Exemptions.**

Research activities in which the only involvement of human subjects will
be in one or more of the following six categories of ***exemptions***
are not covered by the regulations:

\(1\) Research conducted in established or commonly accepted educational
settings, involving normal educational practices, such as (a) research
on regular and special education instructional strategies, or (b)
research on the effectiveness of or the comparison among instructional
techniques, curricula, or classroom management methods.

\(2\) Research involving the use of educational tests (cognitive,
diagnostic, aptitude, achievement), survey procedures, interview
procedures or observation of public behavior, unless: (a) information
obtained is recorded in such a manner that human subjects can be
identified, directly or through identifiers linked to the subjects; and
(b) any disclosure of the human subjects' responses outside the research
could reasonably place the subjects at risk of criminal or civil
liability or be damaging to the subjects' financial standing,
employability, or reputation. ***If the subjects are children, this
exemption applies only to research involving educational tests or
observations of public behavior when the investigator(s) do not
participate in the activities being observed.*** \[Children are defined
as persons who have not attained the legal age for consent to treatments
or procedures involved in the research, under the applicable law or
jurisdiction in which the research will be conducted.\]

\(3\) Research involving the use of educational tests (cognitive,
diagnostic, aptitude, achievement), survey procedures, interview
procedures or observation of public behavior that is not exempt under
section (2) above, if the human subjects are elected or appointed public
officials or candidates for public office; or federal statute(s)
require(s) without exception that the confidentiality of the personally
identifiable information will be maintained throughout the research and
thereafter.

\(4\) Research involving the collection or study of existing data,
documents, records, pathological specimens, or diagnostic specimens, if
these sources are publicly available or if the information is recorded
by the investigator in a manner that subjects cannot be identified,
directly or through identifiers linked to the subjects.

\(5\) Research and demonstration projects which are conducted by or
subject to the approval of department or agency heads, and which are
designed to study, evaluate, or otherwise examine: (a) public benefit or
service programs; (b) procedures for obtaining benefits or services
under those programs; (c) possible changes in or alternatives to those
programs or procedures; or (d) possible changes in methods or levels of
payment for benefits or services under those programs.

\(6\) Taste and food quality evaluation and consumer acceptance studies,
(a) if wholesome foods without additives are consumed or (b) if a food
is consumed that contains a food ingredient at or below the level and
for a use found to be safe, or agricultural chemical or environmental
contaminant at or below the level found to be safe, by the Food and Drug
Administration or approved by the Environmental Protection Agency or the
Food Safety and Inspection Service of the U.S Department of Agriculture.

***Copies of the Department of Education's Regulations for the
Protection of Human Subjects, 34 CFR Part 97 and other pertinent
materials on the protection of human subjects in research are available
from the Grants Policy and Oversight Staff (GPOS) Office of the Chief
Financial and Chief Information Officer, U.S. Department of Education,
Washington, D.C., telephone: (202) 708-8263, and on the U.S. Department
of Education's Protection of Human Subjects in Research Web Site at
http://www.ed.gov/about/offices/list/ocfo/humansub.html.***

> **Instructions for ED 424**
>
> **1.** **Legal Name and Address.** Enter the legal name of applicant
> and the name of the primary organizational unit which will undertake
> the assistance activity.
>
> **2.** **D-U-N-S Number.** Enter the applicant's D-U-N-S Number. If
> your organization does not have a D-U-N-S Number, you can obtain the
> number by calling 1-800-333-0505 or by completing a D-U-N-S Number
> Request Form. The form can be obtained via
>
> the Internet at the following URL: **http://www.dnb.com/.**
>
> **3.** **Catalog of Federal Domestic Assistance** **(CFDA) Number.**
> Enter the CFDA number and title of the program under which assistance
> is requested.
>
> **4.** **Project Director.** Name, address, telephone and fax numbers,
> and e-mail address of the person to be contacted on matters involving
> this application.
>
> **5.** **Federal Debt Delinquency.** Check **"Yes"** if the
> applicant's organization is delinquent on any Federal debt. (This
> question refers to the applicant's organization and not to the person
> who signs as the authorized representative. Categories of debt include
> delinquent audit disallowances, loans and taxes.) Otherwise, check
> **"No."**
>
> **6. Type of Applicant.** Enter the appropriate letter in the box
> provided.
>
> **7. Novice Applicant.** Check **"Yes"** only if assistance is being
> requested under a program that gives special consideration to novice
> applicants and you meet the program requirements for novice
> applicants. By checking "Yes" the applicant certifies that it meets
> the novice applicant requirements specified by ED. Otherwise, check
> **"No."**
>
> **8.** **Type of Submission.** Self-explanatory.
>
> **9.** **Executive Order 12372.** Check **"Yes"** if the application
> is subject to review by Executive Order 12372. Also, please enter the
> month, date, and four (4) digit year (e.g., 12/12/2000). Applicants
> should contact the State Single Point of Contact (SPOC) for Federal
> Executive Order 12372 to determine whether the application is subject
> to the State intergovernmental review process. Otherwise, check
> **"No."**

**10. Proposed Project Dates.** Please enter the month, date, and four
(4) digit year (e.g., 12/12/2000).

**11. Human Subjects.** Check "Yes" **[or]{.underline}** "No". If
research activities involving human subjects are **[not]{.underline}**
planned **[at any time]{.underline}** during the proposed project
period, check **"No."** **The remaining parts of item 11 are then not
applicable.**

If research activities involving human subjects, whether or not exempt
from Federal regulations for the protection of human subjects,
**[are]{.underline}** planned **[at any time]{.underline}** during the
proposed project period, either at the applicant organization or at any
other performance site or collaborating institution, check **"Yes."** If
**[all]{.underline}** the research activities are designated to be
exempt under the regulations, enter, in item 11a, the exemption
number(s) corresponding to one or more of the six exemption categories
listed in **"Protection of Human Subjects in Research"** attached to
this form. Provide sufficient information in the application to allow a
determination that the designated exemptions in item 11a, are
appropriate. **Provide this narrative information in an "Item
11/Protection of Human Subjects Attachment" and insert this attachment
immediately following the ED 424 face page. Skip the remaining parts of
item 11.**

If **[some or all]{.underline}** of the planned research activities
involving human subjects are covered (nonexempt), skip item 11a and
continue with the remaining parts of item 11, as noted below. In
addition, follow the instructions in **"Protection of Human Subjects in
Research"** attached to this form to prepare the six-point narrative
about the nonexempt activities. **Provide this six-point** **narrative
in an "Item 11/Protection of Human Subjects Attachment" and insert this
attachment immediately following the ED 424 face page.**

**If the applicant organization has an approved Multiple Project
Assurance of Compliance** on file with the Grants Policy and Oversight
Staff (GPOS), U.S. Department of Education, or with the Office for
Protection from Research Risks (OPRR), National Institutes of Health,
U.S. Department of Health and Human Services, that covers the specific
activity, enter the Assurance number in item 11b and the date of
approval by the Institutional Review Board (IRB) of the proposed
activities in item 11c. This date must be no earlier than one year
before the receipt date for which the application is submitted and must
include the four (4) digit year (e.g., 2000). Check the type of IRB
review in the appropriate box. An IRB may use the expedited review
procedure if it complies with the requirements of 34 CFR 97.110. If the
IRB review is delayed beyond the submission of the application, enter
**"Pending"** in item 11c. If your application is recommended/selected
for funding, a follow-up certification of IRB approval from an official
signing for the applicant organization must be sent to and received by
the designated ED official within 30 days after a specific formal
request from the designated ED official. **If the applicant organization
does not have** on file with GPOS or OPRR **an approved Assurance of
Compliance** that covers the proposed research activity, enter
**"None"** in item 11b and skip 11c. In this case, the applicant
organization, by the signature on the application, is declaring that it
will comply with 34 CFR 97 within 30 days after a specific formal
request from the designated ED official for the Assurance(s) and IRB
certifications.

**12. Project Title.** Enter a brief descriptive title of the project.
If more than one program is involved, you should append an explanation
on a separate sheet. If appropriate (e.g., construction or real property
projects), attach a map showing project location. For preapplications,
use a separate sheet to provide a summary description of this project.

**13. Estimated Funding.** Amount requested or to be contributed during
the first funding/budget period by each contributor. Value of in-kind
contributions should be included on appropriate lines as applicable. If
the action will result in a dollar change to an existing award, indicate
**[only]{.underline}** the amount of the change. For decreases, enclose
the amounts in parentheses. If both basic and supplemental amounts are
included, show breakdown on an attached sheet. For multiple program
funding, use totals and show breakdown using same categories as item 13.

**14. Certification.** To be signed by the authorized representative of
the applicant. A copy of the governing body's authorization for you to
sign this application as official representative must be on file in the
applicant's office. Be sure to enter the telephone and fax number and
e-mail address of the authorized representative. Also, in item 14e,
please enter the month, date, and four (4) digit year (e.g., 12/12/2000)
in the date signed field.

**Paperwork Burden Statement**

> According to the Paperwork Reduction Act of 1995, no persons are
> required to respond to a collection of information unless such
> collection displays a valid OMB control number. The valid OMB control
> number for this information collection is **1875-0106**. The time
> required to complete this information collection is estimated to
> average between 15 and 45 minutes per response, including the time to
> review instructions, search existing data resources, gather the data
> needed, and complete and review the information collection. **If you
> have any comments concerning the accuracy of the estimate(s) or
> suggestions for improving this form, please write to:** U.S.
> Department of Education, Washington, D.C. 20202-4651. **If you have
> comments or concerns regarding the status of your individual
> submission of this form write directly to:** Joyce I. Mays,
> Application Control Center, U.S. Department of Education, 7th and D
> Streets, S.W. ROB-3, Room 3633,
>
> Washington, D.C. 20202-4725

**Protection of Human Subjects in Research**

**(Attachment to ED 424)**

**I. Instructions to Applicants about the Narrative Information that
Must be Provided if Research Activities Involving Human Subjects are
Planned.**

If you marked item 11 on the application "Yes" and designated exemptions
in 11a , **(all research activities are exempt),** provide sufficient
information in the application to allow a determination that the
designated exemptions are appropriate. Research involving human subjects
that is exempt from the regulations is discussed under **II.B.
"Exemptions,"** below. The Narrative must be succinct. **Provide this
information in an "Item 11/Protection of Human Subjects Attachment" and
insert this attachment immediately following the ED 424 face page.**

If you marked "Yes" to item 11 on the face page, and designated no
exemptions from the regulations **(some or all of the research
activities are nonexempt),** address the following six points for each
nonexempt activity. In addition, if research involving human subjects
will take place at collaborating site(s) or other performance site(s),
provide this information before discussing the six points. Although no
specific page limitation applies to this section of the application, be
succinct. Provide the six-point narrative and discussion of other
performance sites in an **"Item 11/Protection of Human Subjects
Attachment" and insert this attachment immediately following the ED 424
face page.**

\(1\) Provide a detailed description of the proposed involvement of
human subjects. Describe the characteristics of the subject population,
including their anticipated number, age range, and health status.
Identify the criteria for inclusion or exclusion of any subpopulation.
Explain the rationale for the involvement of special classes of
subjects, such as children, children with disabilities, adults with
disabilities, persons with mental disabilities, pregnant women,
prisoners, institutionalized individuals, or others who are likely to be
vulnerable.

\(2\) Identify the sources of research material obtained from
individually identifiable living human subjects in the form of
specimens, records, or data. Indicate whether the material or data will
be obtained specifically for research purposes or whether use will be
made of existing specimens, records, or data.

\(3\) Describe plans for the recruitment of subjects and the consent
procedures to be followed. Include the circumstances under which consent
will be sought and obtained, who will seek it, the nature of the
information to be provided to prospective subjects, and the method of
documenting consent. State if the Institutional Review Board (IRB) has
authorized a modification or waiver of the elements of consent or the
requirement for documentation of consent.

\(4\) Describe potential risks (physical, psychological, social, legal,
or other) and assess their likelihood and seriousness. Where
appropriate, describe alternative treatments and procedures that might
be advantageous to the subjects.

\(5\) Describe the procedures for protecting against or minimizing
potential risks, including risks to confidentiality, and assess their
likely effectiveness. Where appropriate, discuss provisions for ensuring
necessary medical or professional intervention in the event of adverse
effects to the subjects. Also, where appropriate, describe the
provisions for monitoring the data collected to ensure the safety of the
subjects.

\(6\) Discuss why the risks to subjects are reasonable in relation to
the anticipated benefits to subjects and in relation to the importance
of the knowledge that may reasonably be expected to result.

**II. Information on Research Activities**

**Involving Human Subjects**

**A. Definitions.**

A research activity involves human subjects if the activity is research,
as defined in the Department's regulations, and the research activity
will involve use of human subjects, as defined in the regulations.

**---Is it a research activity?**

The ED Regulations for the Protection of Human Subjects, Title 34, Code
of Federal Regulations, Part 97, define research as "a systematic
investigation, including research development, testing and evaluation,
designed to develop or contribute to generalizable knowledge." *If an
activity follows a deliberate plan whose purpose is to develop or
contribute to generalizable knowledge, such as an exploratory study or
the collection of data to test a hypothesis, it is research.* Activities
which meet this definition constitute research whether or not they are
conducted or supported under a program which is considered research for
other purposes. For example, some demonstration and service programs may
include research activities.

**---Is it a human subject?**

The regulations define human subject as "a living individual about whom
an investigator (whether professional or student) conducting research
obtains (1) data through intervention or interaction with the
individual, or (2) identifiable private information." *(1) If an
activity involves obtaining information about a living person by
manipulating that person or that person's environment, as might occur
when a new instructional technique is tested, or by communicating or
interacting with the individual, as occurs with surveys and interviews,
the definition of human subject is met. (2) If an activity involves
obtaining private information about a living person in such a way that
the information can be linked to that individual (the identity of the
subject is or may be readily determined by the investigator or
associated with the information), the definition of human subject is
met.* \[Private information includes information about behavior that
occurs in a context in which an individual can reasonably expect that no
observation or recording is taking place, and information which has been
provided for specific purposes by an individual and which the individual
can reasonably expect will not be made public (for example, a school
health record).\]

**B. Exemptions.**

Research activities in which the only involvement of human subjects will
be in one or more of the following six categories of ***exemptions***
are not covered by the regulations:

\(1\) Research conducted in established or commonly accepted educational
settings, involving normal educational practices, such as (a) research
on regular and special education instructional strategies, or (b)
research on the effectiveness of or the comparison among instructional
techniques, curricula, or classroom management methods.

\(2\) Research involving the use of educational tests (cognitive,
diagnostic, aptitude, achievement), survey procedures, interview
procedures or observation of public behavior, unless: (a) information
obtained is recorded in such a manner that human subjects can be
identified, directly or through identifiers linked to the subjects; and
(b) any disclosure of the human subjects' responses outside the research
could reasonably place the subjects at risk of criminal or civil
liability or be damaging to the subjects' financial standing,
employability, or reputation. ***If the subjects are children, this
exemption applies only to research involving educational tests or
observations of public behavior when the investigator(s) do not
participate in the activities being observed.*** \[Children are defined
as persons who have not attained the legal age for consent to treatments
or procedures involved in the research, under the applicable law or
jurisdiction in which the research will be conducted.\]

\(3\) Research involving the use of educational tests (cognitive,
diagnostic, aptitude, achievement), survey procedures, interview
procedures or observation of public behavior that is not exempt under
section (2) above, if the human subjects are elected or appointed public
officials or candidates for public office; or federal statute(s)
require(s) without exception that the confidentiality of the personally
identifiable information will be maintained throughout the research and
thereafter.

\(4\) Research involving the collection or study of existing data,
documents, records, pathological specimens, or diagnostic specimens, if
these sources are publicly available or if the information is recorded
by the investigator in a manner that subjects cannot be identified,
directly or through identifiers linked to the subjects.

\(5\) Research and demonstration projects which are conducted by or
subject to the approval of department or agency heads, and which are
designed to study, evaluate, or otherwise examine: (a) public benefit or
service programs; (b) procedures for obtaining benefits or services
under those programs; (c) possible changes in or alternatives to those
programs or procedures; or (d) possible changes in methods or levels of
payment for benefits or services under those programs.

\(6\) Taste and food quality evaluation and consumer acceptance studies,
(a) if wholesome foods without additives are consumed or (b) if a food
is consumed that contains a food ingredient at or below the level and
for a use found to be safe, or agricultural chemical or environmental
contaminant at or below the level found to be safe, by the Food and Drug
Administration or approved by the Environmental Protection Agency or the
Food Safety and Inspection Service of the U.S Department of Agriculture.

***Copies of the Department of Education's Regulations for the
Protection of Human Subjects, 34 CFR Part 97 and other pertinent
materials on the protection of human subjects in research are available
from the Grants Policy and Oversight Staff (GPOS) Office of the Chief
Financial and Chief Information Officer, U.S. Department of Education,
Washington, D.C., telephone: (202) 708-8263, and on the U.S. Department
of Education's Protection of Human Subjects in Research Web Site at
http://www.ed.gov/about/offices/list/ocfo/humansub.html***

<table>
<colgroup>
<col style="width: 13%" />
<col style="width: 1%" />
<col style="width: 14%" />
<col style="width: 14%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 13%" />
<col style="width: 0%" />
<col style="width: 14%" />
<col style="width: 14%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="2"></td>
<td colspan="6" rowspan="2"><p><strong>U.S. DEPARTMENT OF
EDUCATION</strong></p>
<p><strong>BUDGET INFORMATION</strong></p>
<p><strong>NON-CONSTRUCTION PROGRAMS</strong></p></td>
<td colspan="3">OMB Control Number: 1890-0004</td>
</tr>
<tr class="even">
<td colspan="3">Expiration Date: 02/28/2003</td>
</tr>
<tr class="odd">
<td colspan="5"><strong>Name of Institution/Organization</strong></td>
<td colspan="5">Applicants requesting funding for only one year should
complete the column under "Project Year 1." Applicants requesting
funding for multi-year grants should complete all applicable columns.
Please read all instructions before completing form.</td>
</tr>
<tr class="even">
<td colspan="10"><p><strong>SECTION A - BUDGET SUMMARY</strong></p>
<p><strong>U.S. DEPARTMENT OF EDUCATION FUNDS</strong></p></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>Budget Categories</strong></td>
<td><p><strong>Project Year 1</strong></p>
<p><strong>(a)</strong></p></td>
<td><p><strong>Project Year 2</strong></p>
<p><strong>(b)</strong></p></td>
<td colspan="2"><p><strong>Project Year 3</strong></p>
<p><strong>(c)</strong></p></td>
<td colspan="2"><p><strong>Project Year 4</strong></p>
<p><strong>(d)</strong></p></td>
<td><p><strong>Project Year 5</strong></p>
<p><strong>(e)</strong></p></td>
<td><p><strong>Total</strong></p>
<p><strong>(f)</strong></p></td>
</tr>
<tr class="even">
<td colspan="2">1. Personnel</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">2. Fringe Benefits</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">3. Travel</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">4. Equipment</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">5. Supplies</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">6. Contractual</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">7. Construction</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">8. Other</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"><p>9. Total Direct Costs</p>
<p>(lines 1-8)</p></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">10. Indirect Costs</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">11, Training Stipends</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"><p>12. Total Costs</p>
<p>(lines 9-11)</p></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

**ED Form No. 524**

+---------+---------+---------+----+----+---------+---------+---------+
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|         |         |         |    | pl |         |         |         |
|         |         |         |    | ic |         |         |         |
|         |         |         |    | an |         |         |         |
|         |         |         |    | ts |         |         |         |
|         |         |         |    | re |         |         |         |
|         |         |         |    | qu |         |         |         |
|         |         |         |    | es |         |         |         |
|         |         |         |    | ti |         |         |         |
|         |         |         |    | ng |         |         |         |
|         |         |         |    | f  |         |         |         |
|         |         |         |    | un |         |         |         |
|         |         |         |    | di |         |         |         |
|         |         |         |    | ng |         |         |         |
|         |         |         |    | f  |         |         |         |
|         |         |         |    | or |         |         |         |
|         |         |         |    | mu |         |         |         |
|         |         |         |    | lt |         |         |         |
|         |         |         |    | i- |         |         |         |
|         |         |         |    | ye |         |         |         |
|         |         |         |    | ar |         |         |         |
|         |         |         |    | gr |         |         |         |
|         |         |         |    | an |         |         |         |
|         |         |         |    | ts |         |         |         |
|         |         |         |    | sh |         |         |         |
|         |         |         |    | ou |         |         |         |
|         |         |         |    | ld |         |         |         |
|         |         |         |    | co |         |         |         |
|         |         |         |    | mp |         |         |         |
|         |         |         |    | le |         |         |         |
|         |         |         |    | te |         |         |         |
|         |         |         |    | a  |         |         |         |
|         |         |         |    | ll |         |         |         |
|         |         |         |    | ap |         |         |         |
|         |         |         |    | pl |         |         |         |
|         |         |         |    | ic |         |         |         |
|         |         |         |    | ab |         |         |         |
|         |         |         |    | le |         |         |         |
|         |         |         |    | co |         |         |         |
|         |         |         |    | lu |         |         |         |
|         |         |         |    | mn |         |         |         |
|         |         |         |    | s. |         |         |         |
|         |         |         |    | Pl |         |         |         |
|         |         |         |    | ea |         |         |         |
|         |         |         |    | se |         |         |         |
|         |         |         |    | re |         |         |         |
|         |         |         |    | ad |         |         |         |
|         |         |         |    | a  |         |         |         |
|         |         |         |    | ll |         |         |         |
|         |         |         |    | in |         |         |         |
|         |         |         |    | st |         |         |         |
|         |         |         |    | ru |         |         |         |
|         |         |         |    | ct |         |         |         |
|         |         |         |    | io |         |         |         |
|         |         |         |    | ns |         |         |         |
|         |         |         |    | be |         |         |         |
|         |         |         |    | fo |         |         |         |
|         |         |         |    | re |         |         |         |
|         |         |         |    | co |         |         |         |
|         |         |         |    | mp |         |         |         |
|         |         |         |    | le |         |         |         |
|         |         |         |    | ti |         |         |         |
|         |         |         |    | ng |         |         |         |
|         |         |         |    | f  |         |         |         |
|         |         |         |    | or |         |         |         |
|         |         |         |    | m. |         |         |         |
+---------+---------+---------+----+----+---------+---------+---------+
| **      |         |         |    |    |         |         |         |
| SECTION |         |         |    |    |         |         |         |
| B -     |         |         |    |    |         |         |         |
| BUDGET  |         |         |    |    |         |         |         |
| SU      |         |         |    |    |         |         |         |
| MMARY** |         |         |    |    |         |         |         |
|         |         |         |    |    |         |         |         |
| **NON-  |         |         |    |    |         |         |         |
| FEDERAL |         |         |    |    |         |         |         |
| FUNDS** |         |         |    |    |         |         |         |
+---------+---------+---------+----+----+---------+---------+---------+
| *       | **      | **      | *  |    | **      | **      | **      |
| *Budget | Project | Project | *P |    | Project | Project | Total** |
| Categ   | Year    | Year    | ro |    | Year    | Year    |         |
| ories** | 1**     | 2**     | je |    | 4**     | 5**     | **(f)** |
|         |         |         | ct |    |         |         |         |
|         | **(a)** | **(b)** | Ye |    | **(d)** | **(e)** |         |
|         |         |         | ar |    |         |         |         |
|         |         |         | 3  |    |         |         |         |
|         |         |         | ** |    |         |         |         |
|         |         |         |    |    |         |         |         |
|         |         |         | *  |    |         |         |         |
|         |         |         | *( |    |         |         |         |
|         |         |         | c) |    |         |         |         |
|         |         |         | ** |    |         |         |         |
+---------+---------+---------+----+----+---------+---------+---------+
| 1\.     |         |         |    |    |         |         |         |
| Pe      |         |         |    |    |         |         |         |
| rsonnel |         |         |    |    |         |         |         |
+---------+---------+---------+----+----+---------+---------+---------+
| 2\.     |         |         |    |    |         |         |         |
| Fringe  |         |         |    |    |         |         |         |
| B       |         |         |    |    |         |         |         |
| enefits |         |         |    |    |         |         |         |
+---------+---------+---------+----+----+---------+---------+---------+
| 3\.     |         |         |    |    |         |         |         |
| Travel  |         |         |    |    |         |         |         |
+---------+---------+---------+----+----+---------+---------+---------+
| 4\.     |         |         |    |    |         |         |         |
| Eq      |         |         |    |    |         |         |         |
| uipment |         |         |    |    |         |         |         |
+---------+---------+---------+----+----+---------+---------+---------+
| 5\.     |         |         |    |    |         |         |         |
| S       |         |         |    |    |         |         |         |
| upplies |         |         |    |    |         |         |         |
+---------+---------+---------+----+----+---------+---------+---------+
| 6\.     |         |         |    |    |         |         |         |
| Cont    |         |         |    |    |         |         |         |
| ractual |         |         |    |    |         |         |         |
+---------+---------+---------+----+----+---------+---------+---------+
| 7\.     |         |         |    |    |         |         |         |
| Const   |         |         |    |    |         |         |         |
| ruction |         |         |    |    |         |         |         |
+---------+---------+---------+----+----+---------+---------+---------+
| 8\.     |         |         |    |    |         |         |         |
| Other   |         |         |    |    |         |         |         |
+---------+---------+---------+----+----+---------+---------+---------+
| 9\.     |         |         |    |    |         |         |         |
| Total   |         |         |    |    |         |         |         |
| Direc   |         |         |    |    |         |         |         |
| Costs   |         |         |    |    |         |         |         |
|         |         |         |    |    |         |         |         |
| (lines  |         |         |    |    |         |         |         |
| 1-8)    |         |         |    |    |         |         |         |
+---------+---------+---------+----+----+---------+---------+---------+
| 10\.    |         |         |    |    |         |         |         |
| I       |         |         |    |    |         |         |         |
| ndirect |         |         |    |    |         |         |         |
| Costs   |         |         |    |    |         |         |         |
+---------+---------+---------+----+----+---------+---------+---------+
| 11,     |         |         |    |    |         |         |         |
| T       |         |         |    |    |         |         |         |
| raining |         |         |    |    |         |         |         |
| S       |         |         |    |    |         |         |         |
| tipends |         |         |    |    |         |         |         |
+---------+---------+---------+----+----+---------+---------+---------+
| 12\.    |         |         |    |    |         |         |         |
| Total   |         |         |    |    |         |         |         |
| Costs   |         |         |    |    |         |         |         |
|         |         |         |    |    |         |         |         |
| (lines  |         |         |    |    |         |         |         |
| 9-11)   |         |         |    |    |         |         |         |
+---------+---------+---------+----+----+---------+---------+---------+
| **      |         |         |    |    |         |         |         |
| SECTION |         |         |    |    |         |         |         |
| C -     |         |         |    |    |         |         |         |
| OTHER   |         |         |    |    |         |         |         |
| BUDGET  |         |         |    |    |         |         |         |
| INFORM  |         |         |    |    |         |         |         |
| ATION** |         |         |    |    |         |         |         |
| (see    |         |         |    |    |         |         |         |
| instru  |         |         |    |    |         |         |         |
| ctions) |         |         |    |    |         |         |         |
+---------+---------+---------+----+----+---------+---------+---------+

**ED Form No. 524**

**Paperwork Burden Statement**

According to the Paperwork Reduction Act of 1995, no persons are
required to respond to a collection of information unless such
collection displays a valid OMB control number. This form is now
undergoing OMB clearance and should be considered draft until a new
valid OMB collection number is obtained.

Public reporting burden for this collection of information is estimated
to vary from 13 to 22 hours per response, with an average of 17.5 hours
per response, including the time reviewing instructions, searching
existing data resources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the U.S.
Department of Education, Information Management and Compliance Division,
Washington, DC 20202-4651; and the Office of Management and Budget,
Paperwork Reduction Project 1875-0102, Washington, DC 20503.

**INSTRUCTIONS FOR ED FORM 524**

**General Instructions**

This form is used to apply to individual U.S. Department of Education
discretionary grant programs. Unless directed otherwise, provide the
same budget information for each year of the multi-year funding request.
Pay attention to applicable program instructions if attached.

**Section A -- Budget Summary: U.S. Department of Education Funds**

All applicants must complete Section A and provide a breakdown by the
applicable budget categories shown in lines 1-11.

Lines 1-11, columns (a)-(e): For each project year for which funding is
requested, show the total amount requested for each applicable budget
category.

Lines 1-11, column (f): Show the multi-year total for each budget
category. If funding is requested for only one project year, leave this
column blank.

Line 12, columns (a)-(e): Show the total budget request for each project
year for which funding is requested.

Line 12, column (f): Show the total amount requested for all project
years. If funding is requested for only one year, leave this space
blank.

**Section B -- Budget Summary: Non-Federal Funds**

If you are required to provide or volunteer to provide matching funds or
other non-Federal resources to the project, these should be shown for
each applicable budget category on lines 1-11 of Section B.

Lines 1-11, columns (a)-(e): For each project year for which matching
funds or other contributions are provided, show the total contribution
for each applicable budget category.

Lines 1-11, column (f): Show the multi-year total for each budget
category. If non-Federal contributions are provided for only one year,
leave this column blank.

Line 12, columns (a)-(e): Show the total matching or other contribution
for each project year.

Line 12, column (f): Show the total amount to be contributed for all
years of the multi-year project. If non-Federal contributions are
provided for only one year, leave this space blank.

**Section C -- Other Budget Information**

*Pay attention to applicable program specific instructions, if
attached.*

Provide an itemized budget breakdown, by project year, for each budget
category listed in Sections A and B.

If applicable to this program, enter the type of indirect rate
(provisional, predetermined, final or fixed) that will be in effect
during the funding period. In addition, enter the estimated amount of
the base to which the rate is applied, and the total indirect expense.

If applicable to this program, provide the rate and base on which fringe
benefits are calculated.

Provide other explanations or comments you deem necessary.

> **OMB Approval No. 0348-0040**
>
> **Assurances: Non-Construction Programs**

Public reporting burden for this collection of information is estimated
to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other
aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork
Reduction Project (0348-0040), Washington, DC 20503.

> **Please do not return your completed form to the Office of Management
> and Budget.**
>
> **Send it to the address provided by the sponsoring agency.**

Note: Certain of these assurances may not be applicable to your project
or program. If you have questions, please contact the awarding agency.
Further, certain Federal awarding agencies may require applicants to
certify to additional assurances. If such is the case, you will be
notified.

As the duly authorized representative of the applicant I certify that
the applicant:

1\. Has the legal authority to apply for Federal assistance, and the
institutional, managerial and financial capability (including funds
sufficient to pay the non-Federal share of project costs) to ensure
proper planning, management, and completion of the project described in
this application.

2\. Will give the awarding agency, the Comptroller General of the United
States, and if appropriate, the State, through any authorized
representative, access to and the right to examine all records, books,
papers, or documents related to the award; and will establish a proper
accounting system in accordance with generally accepted accounting
standards or agency directives.

3\. Will establish safeguards to prohibit employees from using their
positions for a purpose that constitutes or presents the appearance of
personal or organizational conflict of interest, or personal gain.

4\. Will initiate and complete the work within the applicable time frame
after receipt of approval of the awarding agency.

5\. Will comply with the Intergovernmental Personnel Act of 1970 (42
U.S.C. §§4728-4763) relating to prescribed standards for merit systems
for programs funded under one of the nineteen statutes or regulations
specified in Appendix A of OPM\'s Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).

6\. Will comply with all Federal statutes relating to nondiscrimination.
These include but are not limited to: (a) Title VI of the Civil Rights
Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of
race, color or national origin; (b) Title IX of the Education Amendments
of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the
Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits
discrimination on the basis of handicaps; (d) the Age Discrimination Act
of 1975, as amended (42 U.S.C. §§ 6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92-255), as amended, relating to
nondiscrimination on the basis of drug abuse; (f) the Comprehensive
Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on
the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the
Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee-3), as
amended, relating to confidentiality of alcohol and drug abuse patient
records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C.
§§3601 et seq.), as amended, relating to non-discrimination in the sale,
rental or financing of housing; (i) any other nondiscrimination
provisions in the specific statute(s) under which application for
Federal assistance is being made; and (j) the requirements of any other
nondiscrimination statute(s) which may apply to the application.

7\. Will comply, or has already complied, with the requirements of
Titles II and III of the uniform Relocation Assistance and Real Property
Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair
and equitable treatment of persons displaced or whose property is
acquired as a result of Federal or federally assisted programs. These
requirements apply to all interests in real property acquired for
project purposes regardless of Federal participation in purchases.

8\. Will comply with the provisions of the Hatch Act (5 U.S.C.
§§1501-1508 and 7324-7328) which limit the political activities of
employees whose principal employment activities are funded in whole or
in part with Federal funds.

9\. Will comply, as applicable, with the provisions of the Davis-Bacon
Act (40 U.S.C. §§276a to 276a-7), the Copeland Act (40 U.S.C. §§276c and
18 U.S.C. §§874) and the Contract Work Hours and Safety Standards Act
(40 U.S.C. §§327-333), regarding labor standards for federally assisted
construction subagreements.

10\. Will comply, if applicable, with flood insurance purchase
requirements of Section 102(a) of the Flood Disaster Protection Act of
1973 (P.L. 93-234) which requires recipients in a special flood hazard
area to participate in the program and to purchase flood insurance if
the total cost of insurable construction and acquisition is \$10,000 or
more.

11\. Will comply with environmental standards which may be prescribed
pursuant to the following: (a) institution of environmental quality
control measures under the National Environmental Policy Act of 1969
(P.L. 91-190) and Executive Order (EO) 11514; (b) notification of
violating facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in
accordance with EO 11988; (e) assurance of project consistency with the
approved State management program developed under the Coastal Zone
Management Act of 1972 (16 U.S.C. 1451 et seq); (f) conformity of
Federal actions to State (Clear Air) Implementation Plans under Section
176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. 7401 et
seq.); (g) protection of underground sources of drinking water under the
Safe Drinking Water Act of 1974, as amended, (P.L.93-523); and (h)
protection of endangered species under the Endangered Species Act of
1973, as amended, (P.L. 93-205).

12\. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C.
§§1721 et seq) related to protecting components or potential components
of the national wild and scenic rivers system.

13\. Will assist the awarding agency in assuring compliance with Section
106 of the National Historic Preservation Act of 1966, as amended (16
U.S.C. 470), EO 11593 (identification and protection of historic
properties), and the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. 469a-1 et seq.).

14\. Will comply with P.L. 93-348 regarding the protection of human
subjects involved in research, development, and related activities
supported by this award of assistance.

15\. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L.
89-544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the care,
handling, and treatment of warm blooded animals held for research,
teaching, or other activities supported by this award of assistance.

16\. Will comply with the Lead-Based Paint Poisoning Prevention Act (42
U.S.C. §§4801 et seq.) which prohibits the use of lead based paint in
construction or rehabilitation of residence structures.

17\. Will cause to be performed the required financial and compliance
audits in accordance with the Single Audit Act of 1984.

18\. Will comply with all applicable requirements of all other Federal
laws, executive orders, regulations and policies governing this program.

  -------------------------------------- ------------- ------------------
  **Signature of Authorized Certifying   **Title**     
  Official**                                           

  **Applicant Organization**                           **Date Submitted**
  -------------------------------------- ------------- ------------------

> *Authorized for Local Reproduction*
>
> *Standard Form 424 B (4-88) Prescribed by OMB Circular A-102*
>
> **Certifications Regarding Lobbying; Debarment, Suspension and Other**
>
> **Responsibility Matters; and Drug-Free Workplace Requirements**
>
> Applicants should refer to the regulations cited below to determine
> the certification to which they are required to attest. Applicants
> should also review the instructions for certification included in the
> regulations before completing this form. Signature of this form
> provides for compliance with certification requirements under 34 CFR
> Part 82, \"New Restrictions on Lobbying,\" and 34 CFR Part 85,
> \"Government-wide Debarment and Suspension (Nonprocurement) and
> Government-wide Requirements for Drug-Free Workplace (Grants).\" The
> certifications shall be treated as a material representation of fact
> upon which reliance will be placed when the Department of Education
> determines to award the covered transaction, grant, or cooperative
> agreement.
>
> **1. LOBBYING**
>
> As required by Section 1352, Title 31 of the U.S. Code, and
> implemented at 34 CFR Part 82, for persons entering into a grant or
> cooperative agreement over \$100,000, as defined at 34 CFR Part 82,
> Sections 82.105 and 82.110, the applicant certifies that:
>
> \(a\) No Federal appropriated funds have been paid or will be paid, by
> or on behalf of the undersigned, to any person for influencing or
> attempting to influence an officer or employee of any agency, a Member
> of Congress, an officer or employee of Congress, or an employee of a
> Member of Congress in connection with the making of any Federal grant,
> the entering into of any cooperative agreement, and the extension,
> continuation, renewal, amendment, or modification of any Federal grant
> or cooperative agreement;
>
> \(b\) If any funds other than Federal appropriated funds have been
> paid or will be paid to any person for influencing or attempting to
> influence an officer or employee of any agency, a Member of Congress,
> an officer or employee of Congress, or an employee of a Member of
> Congress in connection with this Federal grant or cooperative
> agreement, the undersigned shall complete and submit Standard Form -
> LLL, \"Disclosure Form to Report Lobbying,\" in accordance with its
> instructions;
>
> \(c\) The undersigned shall require that the language of this
> certification be included in the award documents for all subawards at
> all tiers (including subgrants, contracts under grants and cooperative
> agreements, and subcontracts) and that all subrecipients shall certify
> and disclose accordingly.
>
> **2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS**
>
> As required by Executive Order 12549, Debarment and Suspension, and
> implemented at 34 CFR Part 85, for prospective participants in primary
> covered transactions, as defined at 34 CFR Part 85, Sections 85.105
> and 85.110\--
>
> A. The applicant certifies that it and its principals:
>
> \(a\) Are not presently debarred, suspended, proposed for debarment,
> declared ineligible, or voluntarily excluded from covered transactions
> by any Federal department or agency;
>
> \(b\) Have not within a three-year period preceding this application
> been convicted of or had a civil judgement rendered against them for
> commission of fraud or a criminal offense in connection with
> obtaining, attempting to obtain, or performing a public (Federal,
> State, or local) transaction or contract under a public transaction;
> violation of Federal or State antitrust statutes or commission of
> embezzlement, theft, forgery, bribery, falsification or destruction of
> records, making false statements, or receiving stolen property;
>
> \(c\) Are not presently indicted for or otherwise criminally or
> civilly charged by a governmental entity (Federal, State, or local)
> with commission of any of the offenses enumerated in paragraph (1)(b)
> of this certification; and
>
> \(d\) Have not within a three-year period preceding this application
> had one or more public transaction (Federal, State, or local)
> terminated for cause or default; and
>
> B. Where the applicant is unable to certify to any of the statements
> in this certification, he or she shall attach an explanation to this
> application.
>
> **3. DRUG-FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS)**
>
> As required by the Drug-Free Workplace Act of 1988, and implemented at
> 34 CFR Part 85, Subpart F, for grantees, as defined at 34 CFR Part 85,
> Sections 85.605 and 85.610 -
>
> A. The applicant certifies that it will or will continue to provide a
> drug-free workplace by:
>
> \(a\) Publishing a statement notifying employees that the unlawful
> manufacture, distribution, dispensing, possession, or use of a
> controlled substance is prohibited in the grantee\'s workplace and
> specifying the actions that will be taken against employees for
> violation of such prohibition;
>
> \(b\) Establishing an on-going drug-free awareness program to inform
> employees about:
>
> \(1\) The dangers of drug abuse in the workplace;
>
> \(2\) The grantee\'s policy of maintaining a drug-free workplace;
>
> \(3\) Any available drug counseling, rehabilitation, and employee
> assistance programs; and
>
> \(4\) The penalties that may be imposed upon employees for drug abuse
> violations occurring in the workplace;

+------------------------------------+---------------------------------+
| > \(c\) Making it a requirement    | > \(g\) Making a good faith     |
| > that each employee to be engaged | > effort to continue to         |
| > in the performance of the grant  | > maintain a drug-free          |
| > be given a copy of the statement | > workplace through             |
| > required by paragraph (a);       | > implementation of paragraphs  |
| >                                  | > (a), (b), (c), (d), (e), and  |
| > \(d\) Notifying the employee in  | > (f).                          |
| > the statement required by        |                                 |
| > paragraph (a) that, as a         | B. The grantee may insert in    |
| > condition of employment under    | the space provided below the    |
| > the grant, the employee will-    | site(s) for the performance of  |
| >                                  | work done in connection with    |
| > \(1\) Abide by the terms of the  | the specific grant:             |
| > statement; and                   |                                 |
| >                                  | Place of Performance (Street    |
| > \(2\) Notify the employer in     | address. city, county, state,   |
| > writing of his or her conviction | zip code)                       |
| > for a violation of a criminal    |                                 |
| > drug statute occurring in the    | > Check **\[ \]** if there are  |
| > workplace no later than five     | > workplaces on file that are   |
| > calendar days after such         | > not identified here.          |
| > conviction;                      |                                 |
| >                                  | **DRUG-FREE WORKPLACE (GRANTEES |
| > \(e\) Notifying the agency, in   | WHO ARE INDIVIDUALS)**          |
| > writing, within 10 calendar days |                                 |
| > after receiving notice under     | As required by the Drug-Free    |
| > subparagraph (d)(2) from an      | Workplace Act of 1988, and      |
| > employee or otherwise receiving  | implemented at 34 CFR Part 85,  |
| > actual notice of such            | Subpart F, for grantees, as     |
| > conviction. Employers of         | defined at 34 CFR Part 85,      |
| > convicted employees must provide | Sections 85.605 and 85.610-     |
| > notice, including position       |                                 |
| > title, to: Director, Grants      | A. As a condition of the grant, |
| > Policy and Oversight Staff, U.S. | I certify that I will not       |
| > Department of Education, 600     | engage in the unlawful          |
| > Independence Avenue, S.W. (Room  | manufacture, distribution,      |
| > 3652, GSA Regional Office        | dispensing, possession, or use  |
| > Building No. 3), Washington, DC  | of a controlled substance in    |
| > 20202-4248. Notice shall include | conducting any activity with    |
| > the identification number(s) of  | the grant; and                  |
| > each affected grant;             |                                 |
| >                                  | B. If convicted of a criminal   |
| > \(f\) Taking one of the          | drug offense resulting from a   |
| > following actions, within 30     | violation occurring during the  |
| > calendar days of receiving       | conduct of any grant activity,  |
| > notice under subparagraph        | I will report the conviction,   |
| > (d)(2), with respect to any      | in writing, within 10 calendar  |
| > employee who is so convicted-    | days of the conviction, to:     |
| >                                  | Director, Grants Policy and     |
| > \(1\) Taking appropriate         | Oversight Staff, Department of  |
| > personnel action against such an | Education, 600 Independence     |
| > employee, up to and including    | Avenue, S.W. (Room 3652, GSA    |
| > termination, consistent with the | Regional Office Building No.    |
| > requirements of the              | 3), Washington, DC 20202-4248.  |
| > Rehabilitation Act of 1973, as   | Notice shall include the        |
| > amended; or                      | identification number(s) of     |
| >                                  | each affected grant.            |
| > \(2\) Requiring such employee to |                                 |
| > participate satisfactorily in a  |                                 |
| > drug abuse assistance or         |                                 |
| > rehabilitation program approved  |                                 |
| > for such purposes by a Federal,  |                                 |
| > State, or local health, law      |                                 |
| > enforcement, or other            |                                 |
| > appropriate agency;              |                                 |
+------------------------------------+---------------------------------+

> As the duly authorized representative of the applicant, I hereby
> certify that the applicant will comply with the above certifications.

  -----------------------------------------------------------------------
  **NAME OF APPLICANT PR/AWARD NUMBER AND / OR PROJECT NAME**

  **PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE**

  **SIGNATURE DATE**
  -----------------------------------------------------------------------

**ED 80-0013**

**Certification Regarding Debarment, Suspension, Ineligibility and**

**Voluntary Exclusion --- Lower Tier Covered Transactions**

This certification is required by the Department of Education
regulations implementing Executive Order 12549, Debarment and
Suspension, 34 CFR Part 85, for all lower tier transactions meeting the
threshold and tier requirements stated at Section 85.110.

**Instructions for Certification**

1\. By signing and submitting this proposal, the prospective lower tier
participant is providing the certification set out below.

2\. The certification in this clause is a material representation of
fact upon which reliance was placed when this transaction was entered
into. If it is later determined that the prospective lower tier
participant knowingly rendered an erroneous certification, in addition
to other remedies available to the Federal Government, the department or
agency with which this transaction originated may pursue available
remedies, including suspension and/or debarment.

3\. The prospective lower tier participant shall provide immediate
written notice to the person to which this proposal is submitted if at
any time the prospective lower tier participant learns that its
certification was erroneous when submitted or has become erroneous by
reason of changed circumstances.

4\. The terms \"covered transaction,\" \"debarred,\" \"suspended,\"
\"ineligible,\" \"lower tier covered transaction,\" \"participant,\" \"
person,\" \"primary covered transaction,\" \" principal,\" \"proposal,\"
and \"voluntarily excluded,\" as used in this clause, have the meanings
set out in the Definitions and Coverage sections of rules implementing
Executive Order 12549. You may contact the person to which this proposal
is submitted for assistance in obtaining a copy of those regulations.

5\. The prospective lower tier participant agrees by submitting this
proposal that, should the proposed covered transaction be entered into,
it shall not knowingly enter into any lower tier covered transaction
with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this covered transaction,
unless authorized by the department or agency with which this
transaction originated.

6\. The prospective lower tier participant further agrees by submitting
this proposal that it will include the clause titled \"Certification
Regarding Debarment, Suspension, Ineligibility, and Voluntary
Exclusion-Lower Tier Covered Transactions,\" without modification, in
all lower tier covered transactions and in all solicitations for lower
tier covered transactions.

7\. A participant in a covered transaction may rely upon a certification
of a prospective participant in a lower tier covered transaction that it
is not debarred, suspended, ineligible, or voluntarily excluded from the
covered transaction, unless it knows that the certification is
erroneous. A participant may decide the method and frequency by which it
determines the eligibility of its principals. Each participant may but
is not required to, check the Nonprocurement List.

8\. Nothing contained in the foregoing shall be construed to require
establishment of a system of records in order to render in good faith
the certification required by this clause. The knowledge and information
of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business
dealings.

9\. Except for transactions authorized under paragraph 5 of these
instructions, if a participant in a covered transaction knowingly enters
into a lower tier covered transaction with a person who is suspended,
debarred, ineligible, or voluntarily excluded from participation in this
transaction, in addition to other remedies available to the Federal
Government, the department or agency with which this transaction
originated may pursue available remedies, including suspension and/or
debarment.

**Certification**

1\. The prospective lower tier participant certifies, by submission of
this proposal, that neither it nor its principals are presently
debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participation in this transaction by any
Federal department or agency.

2\. Where the prospective lower tier participant is unable to certify to
any of the statements in this certification, such prospective
participant shall attach an explanation to this proposal.

  -----------------------------------------------------------------------

  **NAME OF APPLICANT PR/AWARD NUMBER AND/OR PROJECT NAME**

  **PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE**

  **SIGNATURE DATE**
  -----------------------------------------------------------------------

**ED 80-0014, 9/90 (Replaces GCS-009 (REV 12/88), which is obsolete)**

**Approved by OMB**

**0348-0046**

**Disclosure of Lobbying Activities**

*Complete this form to disclose lobbying activities pursuant to 31
U.S.C. 1352*

*(See reverse for public burden disclosure)*

+----------------------+----------+---------+-------------------------+
| 1.  **Type of        | 2.       |         | 3.  **Report Type:**    |
|     Federal          | **Status |         |                         |
|     Action:**        |     of   |         | a\. initial filing      |
|                      |          |         |                         |
| a\. contract         |  Federal |         | \_\_\_\_\_ b. material  |
|                      |     A    |         | change                  |
| \_\_\_\_ b. grant    | ction:** |         |                         |
|                      |          |         | **For material change   |
| c\. cooperative      | a\.      |         | only:**                 |
| agreement            | bid/o    |         |                         |
|                      | ffer/app |         | Year \_\_\_\_\_\_\_     |
| d\. loan             | lication |         | quarter \_\_\_\_\_\_\_  |
|                      |          |         |                         |
| e\. loan guarantee   | \_       |         | Date of last            |
|                      | \_\_\_\_ |         | repor                   |
| f\. loan insurance   | b.       |         | t\_\_\_\_\_\_\_\_\_\_\_ |
|                      | initial  |         |                         |
|                      | award    |         |                         |
|                      |          |         |                         |
|                      | c\.      |         |                         |
|                      | po       |         |                         |
|                      | st-award |         |                         |
+----------------------+----------+---------+-------------------------+
| 4.  **Name and       |          | 5       |                         |
|     Address of       |          | .  **If |                         |
|     Reporting        |          |     Re  |                         |
|     Entity:**        |          | porting |                         |
|                      |          |         |                         |
| \_\_\_\_ Prime       |          |  Entity |                         |
| \_\_\_\_\_           |          |     in  |                         |
| Subawardee           |          |     No. |                         |
|                      |          |     4   |                         |
| Tier\_\_\_\_\_\_, if |          |     is  |                         |
| Known:               |          |         |                         |
|                      |          |  Subawa |                         |
| **Congressional      |          | rdee,** |                         |
| District, if         |          |         |                         |
| known:**             |          |   Enter |                         |
|                      |          |         |                         |
|                      |          |    Name |                         |
|                      |          |     and |                         |
|                      |          |         |                         |
|                      |          | Address |                         |
|                      |          |     of  |                         |
|                      |          |         |                         |
|                      |          |  Prime: |                         |
|                      |          |         |                         |
|                      |          | *       |                         |
|                      |          | *Congre |                         |
|                      |          | ssional |                         |
|                      |          | Di      |                         |
|                      |          | strict, |                         |
|                      |          | if      |                         |
|                      |          | k       |                         |
|                      |          | nown:** |                         |
+----------------------+----------+---------+-------------------------+
| **6. Federal         |          | **7.    |                         |
| Department/Agency:** |          | Federal |                         |
|                      |          | Program |                         |
|                      |          | Name    |                         |
|                      |          | /Descri |                         |
|                      |          | ption** |                         |
|                      |          |         |                         |
|                      |          | CFDA    |                         |
|                      |          | Number, |                         |
|                      |          | *if     |                         |
|                      |          | appli   |                         |
|                      |          | cable*: |                         |
|                      |          | \       |                         |
|                      |          | _\_\_\_ |                         |
|                      |          | \_\_\_\ |                         |
|                      |          | _\_\_\_ |                         |
|                      |          | \_\_\_\ |                         |
|                      |          | _\_\_\_ |                         |
+----------------------+----------+---------+-------------------------+
| **8. Federal Action  |          | **9.    |                         |
| Number,** *if        |          | Award   |                         |
| known:*              |          | Am      |                         |
|                      |          | ount**, |                         |
|                      |          | *if     |                         |
|                      |          | known:* |                         |
|                      |          |         |                         |
|                      |          | **\$**  |                         |
+----------------------+----------+---------+-------------------------+
| **10. a. Name and    |          | **b.    |                         |
| Address of Lobbying  |          | Indi    |                         |
| Registrant**         |          | viduals |                         |
|                      |          | Per     |                         |
| (if individual, last |          | forming |                         |
| name, first name,    |          | Ser     |                         |
| MI):                 |          | vices** |                         |
|                      |          | *(in    |                         |
|                      |          | cluding |                         |
|                      |          | address |                         |
|                      |          | if      |                         |
|                      |          | di      |                         |
|                      |          | fferent |                         |
|                      |          | from    |                         |
|                      |          | No.     |                         |
|                      |          | 10a)*   |                         |
|                      |          |         |                         |
|                      |          | *(last  |                         |
|                      |          | name,   |                         |
|                      |          | first   |                         |
|                      |          | name,   |                         |
|                      |          | MI):*   |                         |
+----------------------+----------+---------+-------------------------+
| 11\. Information     |          | **Sig   |                         |
| requested through    |          | nature: |                         |
| this form is         |          | \_\_\_\ |                         |
| authorized by title  |          | _\_\_\_ |                         |
| 31 U.S.C. section    |          | \_\_\_\ |                         |
| 1352. This           |          | _\_\_\_ |                         |
| disclosure of        |          | \_\_\_\ |                         |
| lobbying activities  |          | _\_\_\_ |                         |
| is a material        |          | \_\_\_\ |                         |
| representation of    |          | _\_\_\_ |                         |
| fact upon which      |          | \_\_\_\ |                         |
| reliance was placed  |          | _\_\_** |                         |
| by the tier above    |          |         |                         |
| when this            |          | **Print |                         |
| transaction was made |          | Nam     |                         |
| or entered into.     |          | e:\_\_\ |                         |
| This disclosure is   |          | _\_\_\_ |                         |
| required pursuant to |          | \_\_\_\ |                         |
| 31 U.S.C. 1352. This |          | _\_\_\_ |                         |
| information will be  |          | \_\_\_\ |                         |
| reported to the      |          | _\_\_\_ |                         |
| Congress             |          | \_\_\_\ |                         |
| semi-annually and    |          | _\_\_\_ |                         |
| will be available    |          | \_\_\_\ |                         |
| for public           |          | _\_\_** |                         |
| inspection. Any      |          |         |                         |
| person who fails to  |          | **      |                         |
| file the required    |          | Title:\ |                         |
| disclosure shall be  |          | _\_\_\_ |                         |
| subject to a civil   |          | \_\_\_\ |                         |
| penalty of not less  |          | _\_\_\_ |                         |
| than \$10,000 and    |          | \_\_\_\ |                         |
| not more than        |          | _\_\_\_ |                         |
| \$100,000 for each   |          | \_\_\_\ |                         |
| such failure.        |          | _\_\_\_ |                         |
|                      |          | \_\_\_\ |                         |
|                      |          | _\_\_\_ |                         |
|                      |          | \_\_\_\ |                         |
|                      |          | _\_\_** |                         |
|                      |          |         |                         |
|                      |          | **Te    |                         |
|                      |          | lephone |                         |
|                      |          | No.:    |                         |
|                      |          | \_\_    |                         |
|                      |          | \_\_\_\ |                         |
|                      |          | _\_\_\_ |                         |
|                      |          | \_\_\_\ |                         |
|                      |          | _\_\_\_ |                         |
|                      |          | Date:   |                         |
|                      |          | \_      |                         |
|                      |          | \_\_\_\ |                         |
|                      |          | _\_\_** |                         |
+----------------------+----------+---------+-------------------------+
| **Federal Use Only** |          | **Aut   |                         |
|                      |          | horized |                         |
|                      |          | for     |                         |
|                      |          | Local   |                         |
|                      |          | Reprodu |                         |
|                      |          | ction** |                         |
|                      |          |         |                         |
|                      |          | **S     |                         |
|                      |          | tandard |                         |
|                      |          | Form -  |                         |
|                      |          | LLL     |                         |
|                      |          | (Rev.   |                         |
|                      |          | 7-97)** |                         |
+----------------------+----------+---------+-------------------------+

**INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING
ACTIVITIES**

This disclosure form shall be completed by the reporting entity, whether
subawardee or prime Federal recipient, at the initiation or receipt of a
covered Federal action, or a material change to a previous filing,
pursuant to title 31 U.S.C. section 1352. The filing of a form is
required for each payment or agreement to make payment to any lobbying
entity for influencing or attempting to influence an officer or employee
of any agency, a Member of Congress, an officer or employee of Congress,
or an employee of a Member of Congress in connection with a covered
Federal action. Complete all items that apply for both the initial
filing and material change report. Refer to the implementing guidance
published by the Office of Management and Budget for additional
information.

1\. Identify the type of covered Federal action for which lobbying
activity is and/or has been secured to influence the outcome of a
covered Federal action.

2\. Identify the status of the covered Federal action.

3\. Identify the appropriate classification of this report. If this is a
followup report caused by a material change to the information
previously reported, enter the year and quarter in which the change
occurred. Enter the date of the last previously submitted report by this
reporting entity for this covered Federal action.

4\. Enter the full name, address, city, State and zip code of the
reporting entity. Include Congressional District, if known. Check the
appropriate classification of the reporting entity that designates if it
is, or expects to be, a prime or subaward recipient. Identify the tier
of the subawardee, e.g., the first subawardee of the prime is the 1st
tier. Subawards include but are not limited to subcontracts, subgrants
and contract awards under grants.

5\. If the organization filing the report in item 4 checks "Subawardee,"
then enter the full name, address, city, State and zip code of the prime
Federal recipient. Include Congressional District, if known.

6\. Enter the name of the federal agency making the award or loan
commitment. Include at least one organizational level below agency name,
if known. For example, Department of Transportation, United States Coast
Guard.

7\. Enter the Federal program name or description for the covered
Federal action (item 1). If known, enter the full Catalog of Federal
Domestic Assistance (CFDA) number for grants, cooperative agreements,
loans, and loan commitments.

8\. Enter the most appropriate Federal identifying number available for
the Federal action identified in item 1 (e.g., Request for Proposal
(RFP) number; Invitations for Bid (IFB) number; grant announcement
number; the contract, grant, or loan award number; the
application/proposal control number assigned by the Federal agency).
Included prefixes, e.g., "RFP-DE-90-001."

9\. For a covered Federal action where there has been an award or loan
commitment by the Federal agency, enter the Federal amount of the
award/loan commitment for the prime entity identified in item 4 or 5.

10\. (a) Enter the full name, address, city, State and zip code of the
lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by
the reporting entity identified in item 4 to influence the covered
Federal action.

> \(b\) Enter the full names of the individual(s) performing services,
> and include full address if different from 10(a). Enter Last Name,
> First Name, and Middle Initial (MI).

11\. The certifying official shall sign and date the form, print his/her
name, title, and telephone number.

According to the Paperwork Reduction Act, as amended, no persons are
required to respond to a collection of information unless it displays a
valid OMB control Number. The valid OMB control number for this
information collection is OMB No. 0348-0046. Public reporting burden for
this collection of information is estimated to average 10 minutes per
response, including time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. Send comments regarding the
burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the Office of
Management and Budget, Paperwork Reduction Project (0348-0046),
Washington, DC 20503.

# Estimated Public Reporting Burden

According to the Paperwork Reduction Act of 1995, no persons are
required to respond to a collection of information unless it displays a
valid OMB control number. The valid OMB control number for this
information collection is 1810-0616. Expiration date: March 31, 2003.

The time required to complete this information collection is estimated
to average 48 hours (forty-eight hours per response, including the time
to review instructions, search existing data resources, gather the data
needed, and complete and review the information collection.)

If you have any comments concerning the accuracy of the time estimate or
suggestions for improving this form, please write to: U.S. Department of
Education, Washington, D.C. 20202-4651.

If you have comments or concerns regarding the status of your individual
submission of this form, write directly to: Nancy Rhett, U.S. Department
of Education, 400 Maryland Avenue, SW, room 5C-137, Washington DC
20202-6200.

# Intergovernmental Review of Federal Programs

This section applies to each program that is subject to the requirements
of Executive Order 12372 (Intergovernmental Review of Federal Programs)
and the regulations in 34 CFR part 79.

The objective of the Executive order is to foster an intergovernmental
partnership and to strengthen federalism by relying on State and local
processes for State and local government coordination and review of
proposed Federal financial assistance.

Applicants must contact the appropriate State Single Point of Contact to
find out about, and to comply with, the State\'s process under Executive
Order 12372. Applicants proposing to perform activities in more than one
State should immediately contact the Single Point of Contact for each of
those States and follow the procedure established in each of those
States under the Executive order. A listing containing the Single Point
of Contact for each State is included in this appendix.

In States that have not established a process or chosen a program for
review, State, areawide, regional, and local entities may submit
comments directly to the Department.

Any State Process Recommendation and other comments submitted by a State
Single Point of Contact and any comments from State, areawide, regional,
and local entities must be mailed or hand-delivered by the date
indicated in the actual application notice to the following address:

> The Secretary
>
> Re: Executive Order 12372
>
> U.S. Department of Education
>
> Room 7W-100
>
> 400 Maryland Avenue SW
>
> Washington, DC 20202-0124.

Proof of mailing will be determined on the same basis as applications
(see 34 CFR 75.102). Recommendations or comments may be hand-delivered
until 4:30 p.m. (Washington, DC time) on the date indicated in the
actual application notice.

**PLEASE NOTE THAT THE ABOVE ADDRESS IS NOT THE SAME ADDRESS AS THE ONE
TO WHICH THE APPLICANT SUBMITS ITS COMPLETED APPLICATION.**

**DO *NOT* SEND APPLICATIONS TO THE ABOVE ADDRESS**

## State Single Points Of Contact

> **Note: In accordance with Executive Order #12372, this listing
> represents the designated State Single Points of Contact.**
>
> Because participation is voluntary, some States and Territories no
> longer participate in the process. These include: Alabama, Alaska,
> American Samoa, Colorado, Connecticut, Hawaii, Idaho, Kansas,
> Louisiana, Massachusetts, Minnesota, Montana, Nebraska, New Jersey,
> Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee,
> Vermont, Virginia, and Washington.
>
> The jurisdictions not listed no longer participate in the process.
> However, an applicant is still eligible to apply for a grant or grants
> even if its respective State, Territory, Commonwealth, etc., does not
> have a State Single Point of Contact.
>
> **ARIZONA**
>
> Joni Saad
>
> Arizona State Clearinghouse
>
> 3800 N. Central Avenue
>
> Fourteenth Floor
>
> Phoenix, AZ 85012
>
> Telephone: (602) 280-1315
>
> Fax: (602) 280-8144
>
> **ARKANSAS**
>
> Mr. Tracy L. Copeland
>
> Manager, State Clearinghouse
>
> Office of Intergovernmental Services
>
> Department of Finance and Administration
>
> 1515 W. 7th Street, Room 412
>
> Little Rock, AR 72203
>
> Telephone: (501) 682-1074
>
> Fax: (501) 682-5206
>
> **CALIFORNIA**
>
> Grants Coordinator
>
> Office of Planning & Research
>
> 1600 Ninth Street, Room 250
>
> Sacramento, CA 95814
>
> Telephone: (916) 323-7480
>
> Fax: (916) 323-3018
>
> **DELAWARE**
>
> Francine Booth
>
> State Single Point of Contact
>
> Executive Department
>
> Office of the Budget
>
> Thomas Collins Building
>
> P.O. Box 1401
>
> Dover, DE 19903
>
> Telephone: (302) 739-3326
>
> Fax: (302) 739-5661
>
> **DISTRICT OF COLUMBIA**
>
> Charles Nichols
>
> State Single Point of Contact
>
> Office of Grants Mgmt. & Development.
>
> 717 14th Street, NW - Suite 400
>
> Washington, DC 20005
>
> Telephone: (202) 727-6554
>
> Fax: (202) 727-1617
>
> **FLORIDA**
>
> Florida State Clearinghouse
>
> Department of Community Affairs
>
> 22740 Centerview Drive
>
> Tallahassee, FL 32399-2100
>
> Telephone: (904) 922-5438
>
> Fax: (904) 487-2899
>
> **GEORGIA**
>
> Tom L. Reid, III
>
> Coordinator
>
> Georgia State Clearinghouse
>
> 270 Washington Street, S.W. - 8th Floor
>
> Atlanta, GA 30334
>
> Telephone: (404) 656-3855
>
> Fax: (404) 656-3828
>
> **ILLINOIS**
>
> Ms. Virginia Bova, Single Point of Contact
>
> Illinois Department of Commerce and Community Affairs
>
> James R. Thompson Center
>
> 100 West Randolph, Suite 3-400
>
> Chicago, IL 60601
>
> Telephone: (312) 814-6028
>
> Fax: (312) 814-1800
>
> **INDIANA**
>
> Frances Williams
>
> State Budget Agency
>
> 212 State House
>
> Indianapolis, IN 46204-2796
>
> Telephone: (317) 232-5619
>
> Fax: (317) 233-3323
>
> **IOWA**
>
> Steven R. McCann
>
> Division for Community Assistance
>
> Iowa Department of Economic
>
> Development
>
> 200 East Grand Avenue
>
> Des Monies, IA 50309
>
> Telephone: (515) 242-4719
>
> Fax: (515) 242-4809
>
> **KENTUCKY**
>
> Ronald W. Cook
>
> Office of the Governor
>
> Department of Local Government
>
> 1024 Capitol Center Drive - Suite 340
>
> Frankfort, KY 40601-8204
>
> Telephone: (502) 573-2382
>
> Fax: (502) 573-2512
>
> **MAINE**
>
> Joyce Benson
>
> State Planning Office
>
> 184 State Street
>
> 38 State House Station
>
> Augusta, ME 04333
>
> Telephone: (207) 287-3261
>
> Fax: (207) 287-6489
>
> **MARYLAND**
>
> William G. Carroll
>
> Manager, Plan & Project Review
>
> Maryland Office of Planning
>
> 301 W. Preston Street - Room 1104
>
> Baltimore, MD 21201-2365
>
> Staff Contact: Linda Janey
>
> Telephone: (410) 767-4490
>
> Fax: (410) 767-4480
>
> **MICHIGAN**
>
> Richard Pfaff
>
> Southeast Michigan Council of Governments
>
> 660 Plaza Drive - Suite 1900
>
> Detroit, MI 48226
>
> Telephone: (313) 961-4266
>
> Fax: (313) 961-4869
>
> **MISSISSIPPI**
>
> Cathy Mallette
>
> Clearinghouse Officer
>
> Department of Finance and Administration
>
> 550 High Street
>
> Jackson, MS 39302-3087
>
> Telephone: (601) 359-6762
>
> Fax: (601) 359-6764
>
> **MISSOURI**
>
> Lois Pohl
>
> Federal Assistance Clearinghouse
>
> Office of Administration
>
> P.O. Box 809
>
> Room 760, Truman Building
>
> Jefferson City, MO 65102
>
> Telephone: (314) 751-4834
>
> Fax: (314) 751-7819
>
> **NEVADA**
>
> Department of Administration
>
> State Clearinghouse
>
> Capitol Complex
>
> Carson City, NV 89710
>
> Telephone: (702) 687-4065
>
> Fax: (702) 687-3983
>
> **NEW HAMPSHIRE**
>
> Jeffrey H. Taylor
>
> Director, New Hampshire Office of State Planning
>
> Attn: Intergovernmental Review Process
>
> Mike Blake
>
> 2 ½ Beacon Street
>
> Concord, NH 03301
>
> Telephone: (603) 271-2155
>
> Fax: (603) 271-1728
>
> **NEW MEXICO**
>
> Robert Peters
>
> State Budget Division
>
> Room 190 Bataan Memorial Building
>
> Santa Fe, NM 87503
>
> Telephone: (505) 827-3640
>
> **NEW YORK**
>
> New York State Clearinghouse
>
> Division of the Budget
>
> State Capitol
>
> Albany, NY 12224
>
> Telephone: (518) 474-1605
>
> Fax: (518) 486-5617
>
> **NORTH CAROLINA**
>
> Chrys Baggett, Director
>
> N.C. State Clearinghouse
>
> Office of the Secretary of Admin.
>
> 116 West Jones Street - Suite 5106
>
> Raleigh, NC 27603-8003
>
> Telephone: (919) 733-7232
>
> Fax: (919) 733-9571
>
> **NORTH DAKOTA**
>
> North Dakota Single Point of Contact
>
> Office of Intergovernmental Assistance
>
> 600 East Boulevard Avenue
>
> Bismarck, ND 58505-0170
>
> Telephone: (701) 224-2094
>
> Fax: (701) 224-2308
>
> **RHODE ISLAND**
>
> Kevin Nelson
>
> Review Coordinator
>
> Department of Administration
>
> Division of Planning
>
> One Capitol Hill, 4th Floor
>
> Providence, RI 02908-5870
>
> Telephone: (401) 277-2656
>
> Fax: (401) 277-2083
>
> **SOUTH CAROLINA**
>
> Rodney Grizzle
>
> State Single Point of Contact
>
> Grant Services
>
> Office of the Governor
>
> 1205 Pendleton Street - Room 331
>
> Columbia, SC 29201
>
> Telephone: (803) 734-0494
>
> Fax: (803) 734-0356
>
> **TEXAS**
>
> Tom Adams
>
> Governors Office
>
> Director, Intergovernmental Coordination
>
> P.O. Box 12428
>
> Austin, TX 78711
>
> Telephone: (512) 463-1771
>
> Fax: (512) 463-1880
>
> **UTAH**
>
> Carolyn Wright
>
> Utah State Clearinghouse
>
> Office of Planning and Budget
>
> Room 116, State Capitol
>
> Salt Lake City, UT 84114
>
> Telephone: (801) 538-1535
>
> Fax: (801) 538-1547
>
> **WEST VIRGINIA**
>
> Fred Cutlip, Director
>
> Community Development Division
>
> W. Virginia Development Office
>
> Building #6, Room 553
>
> Charleston, WV 25305
>
> Telephone: (304) 558-4010
>
> Fax: (304) 558-3248
>
> **WISCONSIN**
>
> Jeff Smith
>
> Section Chief, State/Federal Relations
>
> Wisconsin Department of Administration
>
> 101 East Wilson Street - 6th Floor
>
> P.O. Box 7868
>
> Madison, WI 53707
>
> Telephone: (608) 266-0267
>
> Fax: (608) 267-6931
>
> **WYOMING**
>
> Matthew Jones
>
> State Single Point of Contact
>
> Office of the Governor
>
> 200 West 24th Street
>
> State Capitol, Room 124
>
> Cheyenne, WY 82002
>
> Telephone: (307) 777-7446
>
> Fax: (307) 632-3909
>
> **TERRITORIES**
>
> **GUAM**
>
> Mr. Giovanni T. Sgambelluri
>
> Director, Bureau of Budget and Management Research
>
> Office of the Governor
>
> P.O. Box 2950
>
> Agana, GU 96910
>
> Telephone: 011-671-472-2285
>
> Fax: 011-671-472-2825
>
> **PUERTO RICO**
>
> Norma Burgos/Jose E. Caro
>
> Chairwoman/Director
>
> Puerto Rico Planning Board
>
> Federal Proposals Review Office
>
> Minillas Government Center
>
> P.O. Box 4119
>
> San Juan, PR 00940-1119
>
> Telephone: (809) 727-4444

\(809\) 723-6190

> Fax: (809) 724-3270

\(809\) 724-3103

> **NORTH MARIANA ISLANDS**
>
> Mr. Alvaro A. Santos, Executive Officer
>
> Office of Management and Budget
>
> Office of the Governor
>
> Saipan, MP 96950
>
> Telephone: 670) 664-2256
>
> Fax: (670) 664-2272
>
> Contact person: Ms. Jacoba T. Seman
>
> Federal Programs Coordinator
>
> Telephone: (670) 664-2289
>
> Fax: (670) 664-2272
>
> **VIRGIN ISLANDS**
>
> Nellon Bowry
>
> Director, Office of Management and Budget
>
> 41 Noregade Emancipation Garden Station
>
> Second Floor
>
> Saint Thomas, VI 00802
>
> *Please direct all questions and*
>
> *correspondence about intergovernmental*
>
> *review to:*
>
> Linda Clarke
>
> \(809\) 774-0750
>
> Fax (809) 776-0069
>
> **Note:** This list is based on the most current information provided
> by the States. Information on any changes or apparent errors should be
> provided to Donna Rivelli (telephone 202 395-5858) at the Office of
> Management and Budget and to the State in question. Changes to the
> list will only be made upon formal notification by the State. The list
> is also published biannually in the Catalog of Federal Domestic
> Assistance.

[^1]: We recommend that the state include any optional members as well,
    but the critical list is of the required members.