> OMB Number: 1840-0785

Expiration Date: 12/31/2009

### **FUND FOR THE IMPROVEMENT OF POSTSECONDARY EDUCATION**

###### **INTERNATIONAL CONSORTIA PROGRAM**

##### Project Title Form

Program\_\_\_\_\_\_\_\_\_\_\_\_\_

**Consortium Members - - U.S. Partners:**

**Lead:**

**Partner:**

**Partner:**

**Consortium Members - - Foreign Partners:**

**Lead:**

**Partner:**

**Partner:**

**Consortium Members - - Foreign Partners:**

**Lead:**

**Partner:**

**Project Title:**

**Abstract of Proposal:**

+-----------------------------------+-----------------------------------+
| **Select project format:**        | **Federal Funds Requested:**      |
|                                   |                                   |
| -   Four-year consortia project   | Year 1:                           |
|                                   | \_\_\_\_\                         |
| -   Two-year consortia project    | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                   |                                   |
|                                   | Year 2:                           |
|                                   | \_\_\_\_\                         |
|                                   | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                   |                                   |
|                                   | Year 3:                           |
|                                   | \_\_\_\_\                         |
|                                   | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                   |                                   |
|                                   | Year 4:                           |
|                                   | \_\_\_\_\                         |
|                                   | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                   |                                   |
|                                   | Total:                            |
|                                   | \_\_\_\_\                         |
|                                   | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------+-----------------------------------+

Form Approved OMB NO:1840-0785

> Expiration Date: 12/31/09

+-----------+-----------+----------+-----------+----------+-----------+
| U.S.      |           |          |           | OMB      |           |
| D         |           |          |           | Control  |           |
| epartment |           |          |           | Number:  |           |
| of        |           |          |           | x        |           |
| Education |           |          |           | xxx-xxxx |           |
|           |           |          |           |          |           |
| Budget    |           |          |           |          |           |
| Summary   |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
|           |           |          |           | Ex       |           |
|           |           |          |           | piration |           |
|           |           |          |           | Date:    |           |
|           |           |          |           | xx       |           |
|           |           |          |           | /xx/xxxx |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 1\.       |           |          | 2\.       |          |           |
| Program   |           |          | Select    |          |           |
| \         |           |          | One: Lead |          |           |
| _\_\_\_\_ |           |          | (fiscal   |          |           |
| \_\_\_\_\ |           |          | agent)    |          |           |
| _\_\_\_\_ |           |          | Partner   |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 3\. Name  |           |          |           |          |           |
| of        |           |          |           |          |           |
| Institu   |           |          |           |          |           |
| tion/Orga |           |          |           |          |           |
| nization: |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| Project   |           |          |           |          |           |
| Costs     |           |          |           |          |           |
| Requested |           |          |           |          |           |
| from      |           |          |           |          |           |
| FIPSE:    |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| Budget    | Project   | Project  | Project   | Project  | Total     |
| C         | Year 1    | Year 2   | Year 3    | Year 4   |           |
| ategories |           |          |           |          | \(e\)     |
|           | \(a\)     | \(b\)    | \(c\)     | \(d\)    |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 4\.       |           |          |           |          |           |
| Personnel |           |          |           |          |           |
|           |           |          |           |          |           |
| (salary & |           |          |           |          |           |
| wages)    |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 5\.       |           |          |           |          |           |
| Fringe    |           |          |           |          |           |
| Benefits  |           |          |           |          |           |
|           |           |          |           |          |           |
| (employee |           |          |           |          |           |
| benefits) |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 6\.       |           |          |           |          |           |
| Travel    |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 7\.       |           |          |           |          |           |
| Equipment |           |          |           |          |           |
| (         |           |          |           |          |           |
| purchase) |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 8\.       |           |          |           |          |           |
| Supplies  |           |          |           |          |           |
|           |           |          |           |          |           |
| (and      |           |          |           |          |           |
| m         |           |          |           |          |           |
| aterials) |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 9\.       |           |          |           |          |           |
| Co        |           |          |           |          |           |
| ntractual |           |          |           |          |           |
|           |           |          |           |          |           |
| (enter    |           |          |           |          |           |
| partner   |           |          |           |          |           |
| totals    |           |          |           |          |           |
| here)     |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 10\.      |           |          |           |          |           |
| Other     |           |          |           |          |           |
|           |           |          |           |          |           |
| (         |           |          |           |          |           |
| equipment |           |          |           |          |           |
| rental,   |           |          |           |          |           |
| printing, |           |          |           |          |           |
| etc.)     |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 11\.      |           |          |           |          |           |
| Total     |           |          |           |          |           |
| Direct    |           |          |           |          |           |
| Costs     |           |          |           |          |           |
| (lines    |           |          |           |          |           |
| 4-10)     |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 12\.      |           |          |           |          |           |
| Indirect  |           |          |           |          |           |
| Costs\*   |           |          |           |          |           |
|           |           |          |           |          |           |
| (8% of    |           |          |           |          |           |
| line 11)  |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 13\.      |           |          |           |          |           |
| Mobility  |           |          |           |          |           |
| Stipends  |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 14\.      |           |          |           |          |           |
| Language  |           |          |           |          |           |
| Stipends  |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 15\.      |           |          |           |          |           |
| Subtotal  |           |          |           |          |           |
| of        |           |          |           |          |           |
| Stipends  |           |          |           |          |           |
|           |           |          |           |          |           |
| (lines    |           |          |           |          |           |
| 13+14)    |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 16\.      |           |          |           |          |           |
| Total     |           |          |           |          |           |
| Requested |           |          |           |          |           |
| from      |           |          |           |          |           |
| FIPSE     |           |          |           |          |           |
| (lines    |           |          |           |          |           |
| 11+12+15) |           |          |           |          |           |
|           |           |          |           |          |           |
| (These    |           |          |           |          |           |
| figures   |           |          |           |          |           |
| should    |           |          |           |          |           |
| appear on |           |          |           |          |           |
| the Title |           |          |           |          |           |
| Form)     |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| Project   |           |          |           |          |           |
| Costs Not |           |          |           |          |           |
| Requested |           |          |           |          |           |
| from      |           |          |           |          |           |
| FIPSE:    |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 17\. Lead |           |          |           |          |           |
| Partner   |           |          |           |          |           |
| no        |           |          |           |          |           |
| n-federal |           |          |           |          |           |
| funds     |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 18\.      |           |          |           |          |           |
| Subcont   |           |          |           |          |           |
| ractor(s) |           |          |           |          |           |
| no        |           |          |           |          |           |
| n-federal |           |          |           |          |           |
| funds     |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| Funds     |           |          |           |          |           |
| Requested |           |          |           |          |           |
| by        |           |          |           |          |           |
| Foreign   |           |          |           |          |           |
| Partners: |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 19a.      |           |          |           |          |           |
| Total     |           |          |           |          |           |
| Requested |           |          |           |          |           |
| from      |           |          |           |          |           |
| Canada    |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 19b.      |           |          |           |          |           |
| Total     |           |          |           |          |           |
| Requested |           |          |           |          |           |
| from      |           |          |           |          |           |
| Mexico    |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 19c.      |           |          |           |          |           |
| Total     |           |          |           |          |           |
| Requested |           |          |           |          |           |
| from      |           |          |           |          |           |
| Brazil    |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| 19d.      |           |          |           |          |           |
| Total     |           |          |           |          |           |
| Requested |           |          |           |          |           |
| from      |           |          |           |          |           |
| Europe    |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+
| \         |           |          |           |          |           |
| *Indirect |           |          |           |          |           |
| Cost      |           |          |           |          |           |
| In        |           |          |           |          |           |
| formation |           |          |           |          |           |
| (To be    |           |          |           |          |           |
| completed |           |          |           |          |           |
| by Your   |           |          |           |          |           |
| Business  |           |          |           |          |           |
| Office):  |           |          |           |          |           |
|           |           |          |           |          |           |
| If you    |           |          |           |          |           |
| are       |           |          |           |          |           |
| r         |           |          |           |          |           |
| equesting |           |          |           |          |           |
| reim      |           |          |           |          |           |
| bursement |           |          |           |          |           |
| for       |           |          |           |          |           |
| indirect  |           |          |           |          |           |
| costs on  |           |          |           |          |           |
| line 12,  |           |          |           |          |           |
| please    |           |          |           |          |           |
| answer    |           |          |           |          |           |
| the       |           |          |           |          |           |
| following |           |          |           |          |           |
| q         |           |          |           |          |           |
| uestions: |           |          |           |          |           |
|           |           |          |           |          |           |
| \(1\) Do  |           |          |           |          |           |
| you have  |           |          |           |          |           |
| an        |           |          |           |          |           |
| Indirect  |           |          |           |          |           |
| Cost Rate |           |          |           |          |           |
| Agreement |           |          |           |          |           |
| approved  |           |          |           |          |           |
| by the    |           |          |           |          |           |
| federal   |           |          |           |          |           |
| go        |           |          |           |          |           |
| vernment? |           |          |           |          |           |
| Yes No    |           |          |           |          |           |
| *(Radio   |           |          |           |          |           |
| Button)*  |           |          |           |          |           |
|           |           |          |           |          |           |
| \(2\) If  |           |          |           |          |           |
| Yes,      |           |          |           |          |           |
| please    |           |          |           |          |           |
| provide   |           |          |           |          |           |
| the       |           |          |           |          |           |
| following |           |          |           |          |           |
| inf       |           |          |           |          |           |
| ormation: |           |          |           |          |           |
|           |           |          |           |          |           |
| -         |           |          |           |          |           |
|    Period |           |          |           |          |           |
|           |           |          |           |          |           |
|   covered |           |          |           |          |           |
|     by    |           |          |           |          |           |
|     the   |           |          |           |          |           |
|           |           |          |           |          |           |
|  Indirect |           |          |           |          |           |
|     Cost  |           |          |           |          |           |
|     Rate  |           |          |           |          |           |
|     A     |           |          |           |          |           |
| greement: |           |          |           |          |           |
|     From: |           |          |           |          |           |
|           |           |          |           |          |           |
|    [mm/dd |           |          |           |          |           |
| /yyyy]{.u |           |          |           |          |           |
| nderline} |           |          |           |          |           |
|     To:   |           |          |           |          |           |
|           |           |          |           |          |           |
|    [mm/dd |           |          |           |          |           |
| /yyyy]{.u |           |          |           |          |           |
| nderline} |           |          |           |          |           |
|           |           |          |           |          |           |
| -         |           |          |           |          |           |
| Approving |           |          |           |          |           |
|           |           |          |           |          |           |
|   federal |           |          |           |          |           |
|           |           |          |           |          |           |
|   agency: |           |          |           |          |           |
|     ED    |           |          |           |          |           |
|     Other |           |          |           |          |           |
|           |           |          |           |          |           |
|   (please |           |          |           |          |           |
|           |           |          |           |          |           |
| specify): |           |          |           |          |           |
|           |           |          |           |          |           |
| \_\_\_\_\ |           |          |           |          |           |
| _\_\_\_\_ |           |          |           |          |           |
| \_\_\_\_\ |           |          |           |          |           |
| _\_\_\_\_ |           |          |           |          |           |
|           |           |          |           |          |           |
|   *(Radio |           |          |           |          |           |
|           |           |          |           |          |           |
|  Button)* |           |          |           |          |           |
|           |           |          |           |          |           |
| \(3\) For |           |          |           |          |           |
| R         |           |          |           |          |           |
| estricted |           |          |           |          |           |
| Rate      |           |          |           |          |           |
| Programs  |           |          |           |          |           |
| (select   |           |          |           |          |           |
| one) - -  |           |          |           |          |           |
| Are you   |           |          |           |          |           |
| using a   |           |          |           |          |           |
| r         |           |          |           |          |           |
| estricted |           |          |           |          |           |
| indirect  |           |          |           |          |           |
| cost rate |           |          |           |          |           |
| that:     |           |          |           |          |           |
|           |           |          |           |          |           |
| Is        |           |          |           |          |           |
| included  |           |          |           |          |           |
| in your   |           |          |           |          |           |
| approved  |           |          |           |          |           |
| Indirect  |           |          |           |          |           |
| Cost Rate |           |          |           |          |           |
| A         |           |          |           |          |           |
| greement? |           |          |           |          |           |
| Or,       |           |          |           |          |           |
| Complies  |           |          |           |          |           |
| with 34   |           |          |           |          |           |
| CFR       |           |          |           |          |           |
| 76.5      |           |          |           |          |           |
| 64(c)(2)? |           |          |           |          |           |
| *(Radio   |           |          |           |          |           |
| Button)*  |           |          |           |          |           |
+-----------+-----------+----------+-----------+----------+-----------+

ED form No. xxx

Form Approved OMB NO:1840-0785

> Expiration Date: 12/31/09

# CONSORTIUM PARTNERS IDENTIFICATION FORM

Program \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Select Country \_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Lead Partner:**

[Name:]{.underline} Prefix: First Name: Middle Name: Last Name: Suffix:

[Name of Institution/Organization:]{.underline}

[Department:]{.underline}

[Complete Address:]{.underline} Street Name1: Street Name2:

City: State/Province: Zip/Postal Code: Country:

[Phone Number:]{.underline}

[Fax Number:]{.underline}

[E-mail Address:]{.underline}

## *Partner Two:* 

[Name:]{.underline} Prefix: First Name: Middle Name: Last Name: Suffix:

[Name of Institution/Organization:]{.underline}

[Department:]{.underline}

[Complete Address:]{.underline} Street Name1: Street Name2:

City: State/Province: Zip/Postal Code: Country:

[Phone Number:]{.underline}

[Fax Number:]{.underline}

[E-mail Address:]{.underline}

## 

**Partner Three:**

[Name:]{.underline} Prefix: First Name: Middle Name: Last Name: Suffix:

[Name of Institution/Organization:]{.underline}

[Department:]{.underline}

[Complete Address:]{.underline} Street Name1: Street Name2:

City: State/Province: Zip/Postal Code: Country:

[Phone Number:]{.underline}

[Fax Number:]{.underline}

[E-mail Address:]{.underline}

**Instructions for Completing the Forms found in the Grants.gov
Application Package for the U.S.-Brazil Higher Education Consortia
Program**

[Application Procedures]{.underline}

Each U.S.-Brazil consortium should prepare a common proposal that
contains the following elements. The proposal should contain sufficient
information and details to allow the evaluators to judge the capacity of
the project to meet the objectives of the U.S.-Brazil Program. You and
your Brazilian lead partners should submit to FIPSE, and CAPES proposals
that are identical in content. **You must** **download the application
package found in Grants.gov to complete and submit the application.**

1.  **SF 424**. Please follow the attached instructions to complete the
    SF 424 on page 42.

2.  **DEPARTMENT OF EDUCATION SUPPLEMENTAL INFORMATION FOR THE SF 424**.
    Please follow the attached instructions to complete the ED
    Supplement to the SF 424 on page 44.

3.  **ED FIPSE PROJECT TITLE FORM**. Complete each item using the
    guidelines below.

**Program:** Select U.S.-Brazil Program

**Consortium Members \-- U.S. Partners:**

Enter the name of the lead U.S. Partner after Lead

Enter the name of the U.S. Partner after Partner

Leave the second Partner blank

**Consortium Members \-- Foreign Partners:**

Enter the name of the lead Foreign Partner (for Brazil) after Lead

Enter the name of the Foreign Partner (for Brazil) after Partner

Leave the second Partner blank

> **Project Title:** Enter the title of the project. There is a 60
> character limit in this field.
>
> **Abstract of Proposal:** Enter a brief summary of the project. This
> should be concise and confined to the space provided, but in no case
> should you leave this space blank. This description should include the
> total number of students in each country to be moved during the
> project. There is a 1000 character limit in this field.
>
> **Select project format:** Select the Four-year or Two-year consortia
> project.
>
> **Federal Funds Requested:** Enter the amount of Federal funds being
> requested from FIPSE in the first year of the project. Because the
> first year is for preparatory work, please limit this request to
> \$30,000. Enter the amount requested for subsequent years of funding.
> Under \"total\" enter the cumulative amount requested for the life of
> the project.

4.  **ED FIPSE BUDGET SUMMARY FORM.** Please follow the attached
    instructions to complete the ED FIPSE Budget Summary form on page
    50.

5.  **ED FIPSE CONSORTIUM PARTNERS IDENTIFICATION FORM.** Please follow
    the attached instructions to complete the ED FIPSE Consortium
    Partners Identification form on page 52. It is essential that you
    list the details of all Brazilian partners.

> PLEASE NOTE: You are required to complete this form for both the lead
> partner and partner two on the original form and the first extracted
> copy. IF YOU DO NOT COMPLETE ALL REQUIRED INFORMATION YOUR APPLICATION
> WILL NOT BE SUBMITTED PROPERLY AND WILL BE REJECTED BY GRANTS.GOV.

6.  **ED ABSTRACT FORM.** You will attach an overview outlining the key
    features of the project, including the total number of students from
    each institution being exchanged over the duration of the project,
    to this form. The summary should include the following items:

-   Title of project.

-   Summary of program and project activities.

-   List of U.S and Brazilian consortium institutions.

-   Number of U.S. and Brazilian students targeted for study abroad.

-   Length of study abroad time.

-   Number of planned bilateral consortium meetings among coordinating
    institutions and approximate location (note: the Annual Meeting
    should count as one per year).

7.  **PROGRAM NARRATIVE ATTACHMENTS FORM**. You will attach your project
    description to this form. In no more than 20 double-spaced pages,
    you should include an overview that describes the project, its
    objectives, strategies for achieving those objectives, and for each
    year of the project, the expected outcomes of the project and how
    success in achieving those objectives would be measured. (For more
    information on the guidelines refer to pages 24 through 37 of this
    instructions document.) *Each application should include a
    well-written evaluation plan aimed at measuring success of the
    project\'s activities and outcomes through solid quantitative and
    qualitative evidence. This plan must be coordinated among partners
    to ensure that the success being measured is consortia-wide.*

PAGE LIMIT:

> A "page" is 8.5" x 11", on one side only, with 1"margins at the top,
> bottom, and both sides.
>
> Double space (no more than three lines per vertical inch) all text in
> the application narrative, including titles, headings, footnotes,
> quotations, reference, and captions, as well as all text in charts,
> tables, figures, and graphs. Use a font that is either 12 point or
> larger or no smaller than 10 pitch (characters per inch). The page
> limit does not apply to the budget section, including the narrative
> budget justification, the assurances and certifications, or the
> abstract, the resumes, the bibliography, or the letters of support.
> Our reviewers will not read any pages of your application that exceed
> the page limit.

8.  **BUDGET NARRATIVE ATTACHMENT FORM.** You will attach the budget
    narrative for each year to this form. The budget narrative should
    detail all expenses for each year of the life of the project and how
    they have been determined.

> The budget should clearly identify travel costs and other relevant
> expenses. It should further indicate how much of this budget is being
> requested from FIPSE and how much is to be covered from other sources.
> Clearly indicate the breakdown of expenses among the Brazilian and
> U.S. consortium members. Where applicable, the narrative must indicate
> the level of financial support from other public and private sources.
>
> Letters of confirmation from these sources should also be attached to
> the "Budget Narrative Attachment Form." For U.S. applicants, the
> budget figures must be submitted in U.S. dollars.

9.  **OTHER ATTACHMENTS FORM**. You will attach three documents to this
    form: Personnel Information; Planning Timetable with Outcomes to be
    Achieved for Each Year of the Project; and Endorsement Letters.
    Please create electronic documents, in .doc, .pdf., or .rtf formats,
    and attach each of these documents separately to the Other
    Attachments Form. The following information should be included in
    each document:

-   PERSONNEL INFORMATION: You should clearly state the qualifications
    of the Project Director and the personnel related to the project.
    Please include in your attachments for the narrative section brief
    one-page bios, highlighting relevant skills and experience of the
    personnel. If you must include a résumé, please limit it to fewer
    than five pages. Only attachments of this information will be
    considered.

-   PLANNING TIMETABLE WITH OUTCOMES TO BE ACHIEVED FOR EACH YEAR OF THE
    PROJECT: Please include a planning chart listing goals and planned
    outcomes. This chart should fit your evaluation plan. Only
    Timetables that are attached will be considered.

-   ENDORSEMENT LETTERS: You may attach letters of support from a senior
    executive officer of each academic partner in the consortium,
    indicating how this project fits within the academic exchange policy
    and the international strategy of the institution, and emphasizing
    what this project will add to that strategy. Other major parties
    involved in the consortium should also indicate in writing their
    commitment to this project. Endorsement letters should be attached
    to the narrative of your application. Only endorsement letters that
    are attached will be considered.

> **INSTRUCTIONS FOR THE SF-424**

***Public reporting burden for this collection of information is
estimated to average 60 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 (0348-0043), 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.*

> This is a standard form (including the continuation sheet) required
> for use as a cover sheet for submission of pre-applications and
> applications and related information under discretionary programs.
> Some of the items are required and some are optional at the discretion
> of the applicant or the Federal agency (agency). Required items are
> identified with an asterisk on the form and are specified in the
> instructions below. In addition to the instructions provided below,
> applicants must consult agency instructions to determine specific
> requirements.

+---+--------------+--------------+----+------------------------------+
| I | Entry:       |              | It | Entry:                       |
| t |              |              | em |                              |
| e |              |              |    |                              |
| m |              |              |    |                              |
+---+--------------+--------------+----+------------------------------+
| 1 | **Type of    |              | 10 | **Name Of Federal Agency**:  |
| \ | S            |              | \. | (Required) Enter the name of |
| . | ubmission:** |              |    | the Federal agency from      |
|   | (Required):  |              |    | which assistance is being    |
|   | Select one   |              |    | requested with this          |
|   | type of      |              |    | application.                 |
|   | submission   |              |    |                              |
|   | in           |              |    |                              |
|   | accordance   |              |    |                              |
|   | with agency  |              |    |                              |
|   | i            |              |    |                              |
|   | nstructions. |              |    |                              |
|   |              |              |    |                              |
|   | -   Pr       |              |    |                              |
|   | eapplication |              |    |                              |
|   |              |              |    |                              |
|   | -            |              |    |                              |
|   |  Application |              |    |                              |
|   |              |              |    |                              |
|   | -   Chang    |              |    |                              |
|   | ed/Corrected |              |    |                              |
|   |              |              |    |                              |
|   |  Application |              |    |                              |
|   |     -- If    |              |    |                              |
|   |              |              |    |                              |
|   |    requested |              |    |                              |
|   |     by the   |              |    |                              |
|   |     agency,  |              |    |                              |
|   |     check if |              |    |                              |
|   |     this     |              |    |                              |
|   |              |              |    |                              |
|   |   submission |              |    |                              |
|   |     is to    |              |    |                              |
|   |     change   |              |    |                              |
|   |     or       |              |    |                              |
|   |     correct  |              |    |                              |
|   |     a        |              |    |                              |
|   |              |              |    |                              |
|   |   previously |              |    |                              |
|   |              |              |    |                              |
|   |    submitted |              |    |                              |
|   |              |              |    |                              |
|   | application. |              |    |                              |
|   |     Unless   |              |    |                              |
|   |              |              |    |                              |
|   |    requested |              |    |                              |
|   |     by the   |              |    |                              |
|   |     agency,  |              |    |                              |
|   |              |              |    |                              |
|   |   applicants |              |    |                              |
|   |     may not  |              |    |                              |
|   |     use this |              |    |                              |
|   |     to       |              |    |                              |
|   |     submit   |              |    |                              |
|   |     changes  |              |    |                              |
|   |     after    |              |    |                              |
|   |     the      |              |    |                              |
|   |     closing  |              |    |                              |
|   |     date.    |              |    |                              |
+---+--------------+--------------+----+------------------------------+
|   |              |              | 11 | **Catalog Of Federal         |
|   |              |              | \. | Domestic Assistance          |
|   |              |              |    | Number/Title:** Enter the    |
|   |              |              |    | Catalog of Federal Domestic  |
|   |              |              |    | Assistance number and title  |
|   |              |              |    | of the program under which   |
|   |              |              |    | assistance is requested, as  |
|   |              |              |    | found in the program         |
|   |              |              |    | announcement, if applicable. |
+---+--------------+--------------+----+------------------------------+
|   |              |              |    |                              |
+---+--------------+--------------+----+------------------------------+
| 2 | **Type of    |              | 12 | **Funding Opportunity        |
| \ | Ap           |              | \. | Number/Title:** (Required)   |
| . | plication**: |              |    | Enter the Funding            |
|   | (Required)   |              |    | Opportunity Number and title |
|   | Select one   |              |    | of the opportunity under     |
|   | type of      |              |    | which assistance is          |
|   | application  |              |    | requested, as found in the   |
|   | in           |              |    | program announcement.        |
|   | accordance   |              |    |                              |
|   | with agency  |              |    |                              |
|   | i            |              |    |                              |
|   | nstructions. |              |    |                              |
|   |              |              |    |                              |
|   | -   New --   |              |    |                              |
|   |     An       |              |    |                              |
|   |              |              |    |                              |
|   |  application |              |    |                              |
|   |     that is  |              |    |                              |
|   |     being    |              |    |                              |
|   |              |              |    |                              |
|   |    submitted |              |    |                              |
|   |     to an    |              |    |                              |
|   |     agency   |              |    |                              |
|   |     for the  |              |    |                              |
|   |     first    |              |    |                              |
|   |     time.    |              |    |                              |
|   |              |              |    |                              |
|   | -   Co       |              |    |                              |
|   | ntinuation - |              |    |                              |
|   |     An       |              |    |                              |
|   |              |              |    |                              |
|   |    extension |              |    |                              |
|   |     for an   |              |    |                              |
|   |              |              |    |                              |
|   |   additional |              |    |                              |
|   |     fu       |              |    |                              |
|   | nding/budget |              |    |                              |
|   |     period   |              |    |                              |
|   |     for a    |              |    |                              |
|   |     project  |              |    |                              |
|   |     with a   |              |    |                              |
|   |              |              |    |                              |
|   |    projected |              |    |                              |
|   |              |              |    |                              |
|   |   completion |              |    |                              |
|   |     date.    |              |    |                              |
|   |     This can |              |    |                              |
|   |     include  |              |    |                              |
|   |              |              |    |                              |
|   |    renewals. |              |    |                              |
|   |              |              |    |                              |
|   | ```{=html}   |              |    |                              |
|   | <!-- -->     |              |    |                              |
|   | ```          |              |    |                              |
|   | -            |              |    |                              |
|   |   Revision - |              |    |                              |
|   |     Any      |              |    |                              |
|   |     change   |              |    |                              |
|   |     in the   |              |    |                              |
|   |     Federal  |              |    |                              |
|   |              |              |    |                              |
|   | Government's |              |    |                              |
|   |              |              |    |                              |
|   |    financial |              |    |                              |
|   |              |              |    |                              |
|   |   obligation |              |    |                              |
|   |     or       |              |    |                              |
|   |              |              |    |                              |
|   |   contingent |              |    |                              |
|   |              |              |    |                              |
|   |    liability |              |    |                              |
|   |     from an  |              |    |                              |
|   |     existing |              |    |                              |
|   |              |              |    |                              |
|   |  obligation. |              |    |                              |
|   |     If a     |              |    |                              |
|   |              |              |    |                              |
|   |    revision, |              |    |                              |
|   |     enter    |              |    |                              |
|   |     the      |              |    |                              |
|   |              |              |    |                              |
|   |  appropriate |              |    |                              |
|   |              |              |    |                              |
|   |   letter(s). |              |    |                              |
|   |     More     |              |    |                              |
|   |     than one |              |    |                              |
|   |     may be   |              |    |                              |
|   |              |              |    |                              |
|   |    selected. |              |    |                              |
|   |     If       |              |    |                              |
|   |              |              |    |                              |
|   |    \"Other\" |              |    |                              |
|   |     is       |              |    |                              |
|   |              |              |    |                              |
|   |    selected, |              |    |                              |
|   |     please   |              |    |                              |
|   |     specify  |              |    |                              |
|   |     in text  |              |    |                              |
|   |     box      |              |    |                              |
|   |              |              |    |                              |
|   |    provided. |              |    |                              |
|   |              |              |    |                              |
|   | A. Increase  |              |    |                              |
|   | Award B.     |              |    |                              |
|   | Decrease     |              |    |                              |
|   | Award        |              |    |                              |
|   |              |              |    |                              |
|   | C. Increase  |              |    |                              |
|   | Duration D.  |              |    |                              |
|   | Decrease     |              |    |                              |
|   | Duration     |              |    |                              |
|   |              |              |    |                              |
|   | E. Other     |              |    |                              |
|   | (specify)    |              |    |                              |
+---+--------------+--------------+----+------------------------------+
|   |              |              | 13 | **Competition Identification |
|   |              |              | \. | Number/Title:** Enter the    |
|   |              |              |    | Competition Identification   |
|   |              |              |    | Number and title of the      |
|   |              |              |    | competition under which      |
|   |              |              |    | assistance is requested, if  |
|   |              |              |    | applicable.                  |
+---+--------------+--------------+----+------------------------------+
|   |              |              | 14 | **Areas Affected By          |
|   |              |              | \. | Project:** List the areas or |
|   |              |              |    | entities using the           |
|   |              |              |    | categories (e.g., cities,    |
|   |              |              |    | counties, states, etc.)      |
|   |              |              |    | specified in agency          |
|   |              |              |    | instructions. Use the        |
|   |              |              |    | continuation sheet to enter  |
|   |              |              |    | additional areas, if needed. |
+---+--------------+--------------+----+------------------------------+
| 3 | **Date       |              | 15 | **Descriptive Title of       |
| \ | Received:**  |              | \. | Applicant's Project:**       |
| . | Leave this   |              |    | (Required) Enter a brief     |
|   | field blank. |              |    | descriptive title of the     |
|   | This date    |              |    | project. If appropriate,     |
|   | will be      |              |    | attach a map showing project |
|   | assigned by  |              |    | location (e.g., construction |
|   | the Federal  |              |    | or real property projects).  |
|   | agency.      |              |    | For pre-applications, attach |
|   |              |              |    | a summary description of the |
|   |              |              |    | project.                     |
+---+--------------+--------------+----+------------------------------+
| 4 | **Applicant  |              |    |                              |
| \ | I            |              |    |                              |
| . | dentifier**: |              |    |                              |
|   | Enter the    |              |    |                              |
|   | entity       |              |    |                              |
|   | identifier   |              |    |                              |
|   | assigned by  |              |    |                              |
|   | the Federal  |              |    |                              |
|   | agency, if   |              |    |                              |
|   | any, or      |              |    |                              |
|   | applicant's  |              |    |                              |
|   | control      |              |    |                              |
|   | number, if   |              |    |                              |
|   | applicable.  |              |    |                              |
+---+--------------+--------------+----+------------------------------+
| 5 | **Federal    |              | 16 | **Congressional Districts    |
| a | Entity       |              | \. | Of**: (Required) 16a. Enter  |
|   | I            |              |    | the applicant's              |
|   | dentifier**: |              |    | Congressional District, and  |
|   | Enter the    |              |    | 16b. Enter all District(s)   |
|   | number       |              |    | affected by the program or   |
|   | assigned to  |              |    | project. Enter in the        |
|   | your         |              |    | format: 2 characters State   |
|   | organization |              |    | Abbreviation -- 3 characters |
|   | by the       |              |    | District Number, e.g.,       |
|   | Federal      |              |    | CA-005 for California        |
|   | Agency, if   |              |    | 5th^th^ district, CA-012 for |
|   | any.         |              |    | California 12^th^ district,  |
|   |              |              |    | NC-103 for North Carolina's  |
|   |              |              |    | 103^rd^ district.            |
|   |              |              |    |                              |
|   |              |              |    | -   If all congressional     |
|   |              |              |    |     districts in a state are |
|   |              |              |    |     affected, enter "all"    |
|   |              |              |    |     for the district number, |
|   |              |              |    |     e.g., MD-all for all     |
|   |              |              |    |     congressional districts  |
|   |              |              |    |     in Maryland.             |
|   |              |              |    |                              |
|   |              |              |    | -   If nationwide, i.e. all  |
|   |              |              |    |     districts within all     |
|   |              |              |    |     states are affected,     |
|   |              |              |    |     enter US-all.            |
|   |              |              |    |                              |
|   |              |              |    | -   If the program/project   |
|   |              |              |    |     is outside the US, enter |
|   |              |              |    |     00-000.                  |
+---+--------------+--------------+----+------------------------------+
| 5 | **Federal    |              |    |                              |
| b | Award        |              |    |                              |
| . | I            |              |    |                              |
|   | dentifier**: |              |    |                              |
|   | For new      |              |    |                              |
|   | applications |              |    |                              |
|   | leave blank. |              |    |                              |
|   | For a        |              |    |                              |
|   | continuation |              |    |                              |
|   | or revision  |              |    |                              |
|   | to an        |              |    |                              |
|   | existing     |              |    |                              |
|   | award, enter |              |    |                              |
|   | the          |              |    |                              |
|   | previously   |              |    |                              |
|   | assigned     |              |    |                              |
|   | Federal      |              |    |                              |
|   | award        |              |    |                              |
|   | identifier   |              |    |                              |
|   | number. If a |              |    |                              |
|   | chang        |              |    |                              |
|   | ed/corrected |              |    |                              |
|   | application, |              |    |                              |
|   | enter the    |              |    |                              |
|   | Federal      |              |    |                              |
|   | Identifier   |              |    |                              |
|   | in           |              |    |                              |
|   | accordance   |              |    |                              |
|   | with agency  |              |    |                              |
|   | i            |              |    |                              |
|   | nstructions. |              |    |                              |
+---+--------------+--------------+----+------------------------------+
| 6 | **Date       |              |    |                              |
| \ | Received by  |              |    |                              |
| . | State:**     |              |    |                              |
|   | Leave this   |              |    |                              |
|   | field blank. |              |    |                              |
|   | This date    |              |    |                              |
|   | will be      |              |    |                              |
|   | assigned by  |              |    |                              |
|   | the State,   |              |    |                              |
|   | if           |              |    |                              |
|   | applicable.  |              |    |                              |
+---+--------------+--------------+----+------------------------------+
| 7 | **State      |              |    |                              |
| \ | Application  |              |    |                              |
| . | I            |              |    |                              |
|   | dentifier:** |              |    |                              |
|   | Leave this   |              |    |                              |
|   | field blank. |              |    |                              |
|   | This         |              |    |                              |
|   | identifier   |              |    |                              |
|   | will be      |              |    |                              |
|   | assigned by  |              |    |                              |
|   | the State,   |              |    |                              |
|   | if           |              |    |                              |
|   | applicable.  |              |    |                              |
+---+--------------+--------------+----+------------------------------+
| 8 | **Applicant  |              |    |                              |
| \ | In           |              |    |                              |
| . | formation**: |              |    |                              |
|   | Enter the    |              |    |                              |
|   | following in |              |    |                              |
|   | accordance   |              |    |                              |
|   | with agency  |              |    |                              |
|   | i            |              |    |                              |
|   | nstructions: |              |    |                              |
|   |              |              |    |                              |
|   | **a. Legal   |              |    |                              |
|   | Name**:      |              |    |                              |
|   | (Required):  |              |    |                              |
|   | Enter the    |              |    |                              |
|   | legal name   |              |    |                              |
|   | of applicant |              |    |                              |
|   | that will    |              |    |                              |
|   | undertake    |              |    |                              |
|   | the          |              |    |                              |
|   | assistance   |              |    |                              |
|   | activity.    |              |    |                              |
|   | This is the  |              |    |                              |
|   | name that    |              |    |                              |
|   | the          |              |    |                              |
|   | organization |              |    |                              |
|   | has          |              |    |                              |
|   | registered   |              |    |                              |
|   | with the     |              |    |                              |
|   | Central      |              |    |                              |
|   | Contractor   |              |    |                              |
|   | Registry.    |              |    |                              |
|   | Information  |              |    |                              |
|   | on           |              |    |                              |
|   | registering  |              |    |                              |
|   | with CCR may |              |    |                              |
|   | be obtained  |              |    |                              |
|   | by visiting  |              |    |                              |
|   | the          |              |    |                              |
|   | Grants.gov   |              |    |                              |
|   | website.     |              |    |                              |
+---+--------------+--------------+----+------------------------------+
|   |              |              |    |                              |
+---+--------------+--------------+----+------------------------------+
|   |              |              | 17 | **Proposed Project Start and |
|   |              |              | \. | End Dates**: (Required)      |
|   |              |              |    | Enter the proposed start     |
|   |              |              |    | date and end date of the     |
|   |              |              |    | project.                     |
+---+--------------+--------------+----+------------------------------+
|   | **b.         |              |    |                              |
|   | Emplo        |              |    |                              |
|   | yer/Taxpayer |              |    |                              |
|   | Number       |              |    |                              |
|   | (EIN/TIN):** |              |    |                              |
|   | (Required):  |              |    |                              |
|   | Enter the    |              |    |                              |
|   | Employer or  |              |    |                              |
|   | Taxpayer     |              |    |                              |
|   | Id           |              |    |                              |
|   | entification |              |    |                              |
|   | Number (EIN  |              |    |                              |
|   | or TIN) as   |              |    |                              |
|   | assigned by  |              |    |                              |
|   | the Internal |              |    |                              |
|   | Revenue      |              |    |                              |
|   | Service. If  |              |    |                              |
|   | your         |              |    |                              |
|   | organization |              |    |                              |
|   | is not in    |              |    |                              |
|   | the US,      |              |    |                              |
|   | enter        |              |    |                              |
|   | 44-4444444.  |              |    |                              |
+---+--------------+--------------+----+------------------------------+
|   |              |              | 18 | **Estimated Funding:**       |
|   |              |              | \. | (Required) Enter the 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 the     |
|   |              |              |    | amount of the change. For    |
|   |              |              |    | decreases, enclose the       |
|   |              |              |    | amounts in parentheses.      |
+---+--------------+--------------+----+------------------------------+
|   | **c.         |              |    |                              |
|   | Or           |              |    |                              |
|   | ganizational |              |    |                              |
|   | DUNS**:      |              |    |                              |
|   | (Required)   |              |    |                              |
|   | Enter the    |              |    |                              |
|   | or           |              |    |                              |
|   | ganization's |              |    |                              |
|   | DUNS or      |              |    |                              |
|   | DUNS+4       |              |    |                              |
|   | number       |              |    |                              |
|   | received     |              |    |                              |
|   | from Dun and |              |    |                              |
|   | Bradstreet.  |              |    |                              |
|   | Information  |              |    |                              |
|   | on obtaining |              |    |                              |
|   | a DUNS       |              |    |                              |
|   | number may   |              |    |                              |
|   | be obtained  |              |    |                              |
|   | by visiting  |              |    |                              |
|   | the          |              |    |                              |
|   | Grants.gov   |              |    |                              |
|   | website.     |              |    |                              |
+---+--------------+--------------+----+------------------------------+
|   | **d.         |              |    |                              |
|   | Address**:   |              |    |                              |
|   | Enter the    |              |    |                              |
|   | complete     |              |    |                              |
|   | address as   |              |    |                              |
|   | follows:     |              |    |                              |
|   | Street       |              |    |                              |
|   | address      |              |    |                              |
|   | (Line 1      |              |    |                              |
|   | required),   |              |    |                              |
|   | City         |              |    |                              |
|   | (Required),  |              |    |                              |
|   | County,      |              |    |                              |
|   | State        |              |    |                              |
|   | (Required,   |              |    |                              |
|   | if country   |              |    |                              |
|   | is US),      |              |    |                              |
|   | Province,    |              |    |                              |
|   | Country      |              |    |                              |
|   | (Required),  |              |    |                              |
|   | Zip/Postal   |              |    |                              |
|   | Code         |              |    |                              |
|   | (Required,   |              |    |                              |
|   | if country   |              |    |                              |
|   | is US).      |              |    |                              |
+---+--------------+--------------+----+------------------------------+
|   |              |              | 19 | **Is Application Subject to  |
|   |              |              | \. | Review by State Under        |
|   |              |              |    | Executive Order 12372        |
|   |              |              |    | Process?** 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. Select the          |
|   |              |              |    | appropriate box. If "a." is  |
|   |              |              |    | selected, enter the date the |
|   |              |              |    | application was submitted to |
|   |              |              |    | the State                    |
+---+--------------+--------------+----+------------------------------+
|   | **e.         |              |    |                              |
|   | Or           |              |    |                              |
|   | ganizational |              |    |                              |
|   | Unit:**      |              |    |                              |
|   | Enter the    |              |    |                              |
|   | name of the  |              |    |                              |
|   | primary      |              |    |                              |
|   | or           |              |    |                              |
|   | ganizational |              |    |                              |
|   | unit (and    |              |    |                              |
|   | department   |              |    |                              |
|   | or division, |              |    |                              |
|   | if           |              |    |                              |
|   | app          |              |    |                              |
|   | licable**)** |              |    |                              |
|   | that will    |              |    |                              |
|   | undertake    |              |    |                              |
|   | the          |              |    |                              |
|   | assistance   |              |    |                              |
|   | activity, if |              |    |                              |
|   | applicable.  |              |    |                              |
+---+--------------+--------------+----+------------------------------+
|   |              |              |    |                              |
+---+--------------+--------------+----+------------------------------+
|   |              |              |    |                              |
+---+--------------+--------------+----+------------------------------+
|   | **f. Name    |              |    |                              |
|   | and contact  |              |    |                              |
|   | information  |              |    |                              |
|   | of person to |              |    |                              |
|   | be contacted |              |    |                              |
|   | on matters   |              |    |                              |
|   | involving    |              |    |                              |
|   | this         |              |    |                              |
|   | ap           |              |    |                              |
|   | plication**: |              |    |                              |
|   | Enter the    |              |    |                              |
|   | name (First  |              |    |                              |
|   | and last     |              |    |                              |
|   | name         |              |    |                              |
|   | required),   |              |    |                              |
|   | or           |              |    |                              |
|   | ganizational |              |    |                              |
|   | affiliation  |              |    |                              |
|   | (if          |              |    |                              |
|   | affiliated   |              |    |                              |
|   | with an      |              |    |                              |
|   | organization |              |    |                              |
|   | other than   |              |    |                              |
|   | the          |              |    |                              |
|   | applicant    |              |    |                              |
|   | or           |              |    |                              |
|   | ganization), |              |    |                              |
|   | telephone    |              |    |                              |
|   | number       |              |    |                              |
|   | (Required),  |              |    |                              |
|   | fax number,  |              |    |                              |
|   | and email    |              |    |                              |
|   | address      |              |    |                              |
|   | (Required)   |              |    |                              |
|   | of the       |              |    |                              |
|   | person to    |              |    |                              |
|   | contact on   |              |    |                              |
|   | matters      |              |    |                              |
|   | related to   |              |    |                              |
|   | this         |              |    |                              |
|   | application. |              |    |                              |
+---+--------------+--------------+----+------------------------------+
|   |              |              | 20 | **Is the Applicant           |
|   |              |              | \. | Delinquent on any Federal    |
|   |              |              |    | Debt?** (Required) Select    |
|   |              |              |    | the appropriate box. This    |
|   |              |              |    | question applies to the      |
|   |              |              |    | applicant organization, not  |
|   |              |              |    | the person who signs as the  |
|   |              |              |    | authorized representative.   |
|   |              |              |    | Categories of debt include   |
|   |              |              |    | delinquent audit             |
|   |              |              |    | disallowances, loans and     |
|   |              |              |    | taxes.                       |
|   |              |              |    |                              |
|   |              |              |    | If yes, include an           |
|   |              |              |    | explanation on the           |
|   |              |              |    | continuation sheet.          |
+---+--------------+--------------+----+------------------------------+
|   |              |              |    |                              |
+---+--------------+--------------+----+------------------------------+
| 9 | Type of      |              | 21 | **Authorized                 |
| \ | Applicant:   |              | \. | Representative**: (Required) |
| . | (Required)   |              |    | To be signed and dated by    |
|   |              |              |    | the authorized               |
|   | Select up to |              |    | representative of the        |
|   | three        |              |    | applicant organization.      |
|   | applicant    |              |    | Enter the name (First and    |
|   | type(s) in   |              |    | last name required) title    |
|   | accordance   |              |    | (Required), telephone number |
|   | with agency  |              |    | (Required), fax number, and  |
|   | i            |              |    | email address (Required) of  |
|   | nstructions. |              |    | the person authorized to     |
|   |              |              |    | sign for the applicant.      |
|   |              |              |    |                              |
|   |              |              |    | A copy of the governing      |
|   |              |              |    | body's authorization for you |
|   |              |              |    | to sign this application as  |
|   |              |              |    | the official representative  |
|   |              |              |    | must be on file in the       |
|   |              |              |    | applicant's office. (Certain |
|   |              |              |    | Federal agencies may require |
|   |              |              |    | that this authorization be   |
|   |              |              |    | submitted as part of the     |
|   |              |              |    | application.)                |
+---+--------------+--------------+----+------------------------------+
|   | A.  State    | L            |    |                              |
|   |              | .  Nonprofit |    |                              |
|   |   Government |     with     |    |                              |
|   |              |     501C3    |    |                              |
|   | ```{=html}   |     IRS      |    |                              |
|   | <!-- -->     |     Status   |    |                              |
|   | ```          |     (Other   |    |                              |
|   | A.  County   |     than     |    |                              |
|   |              |              |    |                              |
|   |   Government |  Institution |    |                              |
|   |              |     of       |    |                              |
|   | B.  City or  |     Higher   |    |                              |
|   |     Township |              |    |                              |
|   |              |   Education) |    |                              |
|   |   Government |              |    |                              |
|   |              | M            |    |                              |
|   | C.  Special  | .  Nonprofit |    |                              |
|   |     District |     without  |    |                              |
|   |              |     501C3    |    |                              |
|   |   Government |     IRS      |    |                              |
|   |              |     Status   |    |                              |
|   | D.  Regional |     (Other   |    |                              |
|   |              |     than     |    |                              |
|   | Organization |              |    |                              |
|   |              |  Institution |    |                              |
|   | E.  U.S.     |     of       |    |                              |
|   |              |     Higher   |    |                              |
|   |    Territory |              |    |                              |
|   |     or       |   Education) |    |                              |
|   |              |              |    |                              |
|   |   Possession | N.  Private  |    |                              |
|   |              |              |    |                              |
|   | F.           |  Institution |    |                              |
|   |  Independent |     of       |    |                              |
|   |     School   |     Higher   |    |                              |
|   |     District |              |    |                              |
|   |              |    Education |    |                              |
|   | G.           |              |    |                              |
|   | Public/State | O.           |    |                              |
|   |              |   Individual |    |                              |
|   |   Controlled |              |    |                              |
|   |              | P.           |    |                              |
|   |  Institution |   For-Profit |    |                              |
|   |     of       |              |    |                              |
|   |     Higher   | Organization |    |                              |
|   |              |     (Other   |    |                              |
|   |    Education |     than     |    |                              |
|   |              |     Small    |    |                              |
|   | H.  I        |              |    |                              |
|   | ndian/Native |    Business) |    |                              |
|   |     American |              |    |                              |
|   |     Tribal   | Q.  Small    |    |                              |
|   |              |     Business |    |                              |
|   |   Government |              |    |                              |
|   |              | R.  Hisp     |    |                              |
|   |   (Federally | anic-serving |    |                              |
|   |              |              |    |                              |
|   |  Recognized) |  Institution |    |                              |
|   |              |              |    |                              |
|   | I.  I        | S.           |    |                              |
|   | ndian/Native | Historically |    |                              |
|   |     American |     Black    |    |                              |
|   |     Tribal   |     Colleges |    |                              |
|   |              |     and      |    |                              |
|   |   Government |              |    |                              |
|   |     (Other   | Universities |    |                              |
|   |     than     |     (HBCUs)  |    |                              |
|   |              |              |    |                              |
|   |    Federally | T.  Tribally |    |                              |
|   |              |              |    |                              |
|   |  Recognized) |   Controlled |    |                              |
|   |              |     Colleges |    |                              |
|   | J.  I        |     and      |    |                              |
|   | ndian/Native |              |    |                              |
|   |     American | Universities |    |                              |
|   |     Tribally |     (TCCUs)  |    |                              |
|   |              |              |    |                              |
|   |   Designated | U.  Alaska   |    |                              |
|   |              |     Native   |    |                              |
|   | Organization |     and      |    |                              |
|   |              |     Native   |    |                              |
|   | K.  P        |     Hawaiian |    |                              |
|   | ublic/Indian |     Serving  |    |                              |
|   |     Housing  |              |    |                              |
|   |              | Institutions |    |                              |
|   |    Authority |              |    |                              |
|   |              | V.           |    |                              |
|   |              | Non-domestic |    |                              |
|   |              |     (non-US) |    |                              |
|   |              |     Entity   |    |                              |
|   |              |              |    |                              |
|   |              | W.  Other    |    |                              |
|   |              |              |    |                              |
|   |              |    (specify) |    |                              |
+---+--------------+--------------+----+------------------------------+
|   |              |              |    |                              |
+---+--------------+--------------+----+------------------------------+
|   |              |              |    |                              |
+---+--------------+--------------+----+------------------------------+
|   |              |              |    |                              |
+---+--------------+--------------+----+------------------------------+

# 

# INSTRUCTIONS FOR

**DEPARTMENT OF EDUCATION SUPPLEMENTAL INFORMATION FOR SF 424**

a.  Project Director. Name, address, telephone and fax numbers, and
    e-mail address of the person to be contacted on matters involving
    this application.

2\. Novice Applicant. Check "Yes" or "No" only if assistance is being
requested under a program that gives special consideration to novice
applicants. Otherwise, leave blank.

Check "Yes" if you meet the requirements for novice applicants specified
in the regulations in 34 CFR 75.225 and included on the attached page
entitled "Definitions for Department of Education Supplemental
Information for SF 424." By checking "Yes" the applicant certifies that
it meets these novice applicant requirements. Check "No" if you do not
meet the requirements for novice applicants.

3\. Human Subjects Research. (See I. A. "Definitions" in attached page
entitled "Definitions for Department of Education Supplemental
Information For SF 424.")

If Not Human Subjects Research. Check "No" if research activities
involving human subjects are not planned at any time during the proposed
project period. The remaining parts of Item 3 are then not applicable.

If Human Subjects Research. Check "Yes" if research activities involving
human subjects are planned at any time during the proposed project
period, either at the applicant organization or at any other performance
site or collaborating institution. Check "Yes" even if the research is
exempt from the regulations for the protection of human subjects. (See
I. B. "Exemptions" in attached page entitled "Definitions for Department
of Education Supplemental Information For SF 424.")

3a. If Human Subjects Research is Exempt from the Human Subjects
Regulations. Check "Yes" if all the research activities proposed are
designated to be exempt from the regulations. Insert the exemption
number(s) corresponding to one or more of the six exemption categories
listed in I. B. "Exemptions." In addition, follow the instructions in
II. A. "Exempt Research Narrative" in the attached page entitled
"Definitions for Department of Education Supplemental Information For SF
424."

3a. If Human Subjects Research is Not Exempt from Human Subjects
Regulations. Check "No" if some or all of the planned research
activities are covered (not exempt). In

addition, follow the instructions in II. B. "Nonexempt Research
Narrative" in the page entitled "Definitions for Department of Education
Supplemental Information For SF 424

3a. Human Subjects Assurance Number. If the applicant has an approved
Federal Wide (FWA) on file with the Office for Human Research
Protections (OHRP), U.S. Department of Health and Human Services, that
covers the specific activity, insert the number in the space provided.
If the applicant does not have an approved assurance on file with OHRP,
enter "None." In this case, the applicant, by signature on the SF-424,
is declaring that it will comply with 34 CFR 97 and proceed to obtain
the human subjects assurance upon request by the designated ED official.
If the application is recommended/selected for funding, the designated
ED official will request that the applicant obtain the assurance within
30 days after the specific formal request.

Note about Institutional Review Board Approval. ED does not require
certification of Institutional Review Board approval with the
application. However, if an application that involves non-exempt human
subjects research is recommended/selected for funding, the designated ED
official will request that the applicant obtain and send the
certification to ED within 30 days after the formal request.

## 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 1890-0017. 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, DC 20202-4700. 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, Potomac Center Plaza, 550 12^th^ Street, S.W. Room 7076, Washington, DC 20202-4260. 

# DEFINITIONS FOR

# DEPARTMENT OF EDUCATION SUPPLEMENTAL INFORMATION FOR SF 424

# **(Attachment to Instructions for Supplemental Information for SF 424)**

Definitions:

Novice Applicant (See 34 CFR 75.225). For discretionary grant programs
under which the Secretary gives special consideration to novice
applications, a novice applicant means any applicant for a grant from ED
that---

-   Has never received a grant or sub-grant under the program from which
    it seeks funding;

-   Has never been a member of a group application, submitted in
    accordance with 34 CFR 75.127-75.129, that received a grant under
    the program from which it seeks funding; and

-   Has not had an active discretionary grant from the Federal
    government in the five years before the deadline date for
    applications under the program. For the purposes of this
    requirement, a grant is active until the end of the grant's project
    or funding period, including any extensions of those periods that
    extend the grantee's authority to obligate funds.

In the case of a group application submitted in accordance with 34 CFR
75.127-75.129, a group includes only parties that meet the requirements
listed above.

PROTECTION OF HUMAN SUBJECTS IN RESEARCH

I. Definitions and Exemptions

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.

---Research

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 it is research. Activities, which
meet this definition constitute research whether or not they are
conducted or supported under a program that is considered research for
other purposes. For example, some demonstration and service programs may
include research activities.

---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, exemption 2
applies only to research involving educational tests and observations of
public behavior when the investigator(s) do not participate in the
activities being observed. Exemption 2 does not apply if children are
surveyed or interviewed or if the research involves observation of
public behavior and the investigator(s) 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.

II\. Instructions for Exempt and Nonexempt Human Subjects Research
Narratives

If the applicant marked "Yes" for Item 3 of Department of Education
Supplemental Information for SF 424, the applicant must provide a human
subjects "exempt research" or "nonexempt research" narrative. Insert the
narrative(s) in the space provided. If you have multiple projects and
need to provide more than one narrative, be sure to label each set of
responses as to the project they address.

A. Exempt Research Narrative.

If you marked "Yes" for item 3 a. and designated exemption numbers(s),
provide the "exempt research" narrative. The narrative must contain
sufficient information about the involvement of human subjects in the
proposed research to

allow a determination by ED that the designated exemption(s) are
appropriate. The narrative must be succinct.

B. Nonexempt Research Narrative.

If you marked "No" for item 3 a. you must provide the "nonexempt
research" narrative. The narrative must address the following seven
points. Although no specific page limitation applies to this section of
the application, be succinct.

\(1\) Human Subjects Involvement and Characteristics: 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

\(2\) Sources of Materials: 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.

\(3\) Recruitment and Informed Consent: 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.

\(4\) Potential Risks: 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.

\(5\) Protection Against Risk: 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.

\(6\) Importance of the Knowledge to be Gained: Discuss the importance
of the knowledge gained or to be gained as a result of the proposed
research. 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.

\(7\) Collaborating Site(s): If research involving human subjects will
take place at collaborating site(s) or other performance site(s), name
the sites and briefly describe their involvement or role in the
research.

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, Office of the Chief Financial Officer, U.S.
Department of Education, Washington, DC 20202-4250, telephone: (202)
245-6120, and on the U.S. Department of Education's Protection of Human
Subjects in Research Web Site:
http://www.ed.gov/about/offices/list/OCFO/humansub.html

NOTE: The State Applicant Identifier on the SF 424 is for State Use
only. Please complete it on the OMB Standard 424 in the upper right
corner of the form (if applicable).

######## **Instructions Summary Budget Form for U.S. Lead/ Fiscal Agent**

**1. Program:** Select U.S.-Brazil Program.

**2. Select One:** Please select Lead (fiscal agent).

**3.** **Name of Institution/Organization:** Please fill in name of
institution/organization. The Summary Budget Form must list totals for
the U.S. lead plus the total of the partners as subcontracts (in line
7). Please enter amounts in whole dollars. Please attach the budget
narrative and a spreadsheet with detailed explanations for lead
institution and partners to the "Budget Narrative Attachment Form." For
example, for the salary category, please list the name of the individual
and how the salary request is being calculated. Subcontract (partner)
budget must be calculated in the budget narrative to be attached to the
"Budget Narrative Attachment Form."

**4. Personnel (Salary & Wages)**: Enter totals for the salaries and
wages for the U.S. Lead only.

**5. Fringe Benefits (Employee Benefits)**: Enter totals for the U.S.
lead only.

**6. Travel**: Enter travel costs for the U.S. lead only. There are two
major categories of travel---1) the annual program meeting for all
projects (fall 2007 in the United States , fall 2007 in Brazil), 2)
individual consortium meetings (in the United States or Brazil). Travel
funds for a second individual consortium meeting in the United States or
in Brazil should also be submitted for each budget year. Typically a
consortium meets twice in each year of the grant---once at the annual
program meeting in the fall and once at a separate meeting for the
individual consortium (either in the United States or Brazil).

**7. Equipment (Purchase).** FIPSE does not typically cover equipment
purchases**.**

**8. Supplies (and materials)**: Enter total for the U.S. lead only.

**9. Contractual (enter partner totals here)**: Enter total for
subcontracts with the partner institutions, consulting and evaluation.
The recommended consulting amount, including travel costs, for a
consortium is \$5000 budgeted over four years.

**10. Other (equipment rental, printing, etc.)**: Enter totals for the
U.S. lead only.

**11. Total Direct Cost.** Field is calculated automatically.

**12. Indirect Costs**: Indirect costs are limited to items totaled
under line 11 (Total Direct Cost). The U.S. Department of Education uses
a training rate of 8 percent for grants in the U.S.-Brazil Program. The
8 percent training rate applies to all U.S. partners in the consortium.

**13. Mobility Stipends**: Enter the number of students from all
partners who will be studying abroad and the minimum stipend amount
(minimum 8 students at \$3500 each for the U.S. lead and the U.S.
partner.) The minimum amount budgeted must be \$42,000 and should be
entered only for years two, three, and four. This is a "training
stipend" and is restricted to student use only. More mobility stipends
may be requested but this will not increase the total amount of the
grant. Mobility stipends are entered only on the U.S. lead /fiscal agent
budget. Note: Consistent with EDGAR 75.562, c, and 75.564, stipends are
not subject to indirect cost.

**14. Language Stipends**: Enter the number of students from all
partners who will be studying abroad and the minimum stipend amount (up
to \$1000 per student for the U.S. lead and the U.S. partner.) The
language stipend may be used in years one, two, three, and four. This is
a "training stipend" and is restricted to student use only. Note:
Consistent with EDGAR 75.562, c, and 75.564, stipends are not subject to
indirect cost. Unused funds in this line may only be used for additional
mobility stipends. Language stipends are entered only on the U.S. lead
/fiscal agent budget. This is an optional item in the budget.

**15. Subtotal of Stipends (lines 13 + 14)**: Field is calculated
automatically.

**16. Total requested from FIPSE (lines 11 + 12+ 15) (These figures
should appear on the Title Form)**: Field is calculated automatically.

**17.** **Lead Partner Non-Federal Funds**: Enter total funding not
requested from FIPSE.

**18.** **Subcontractor(s) Partner Non-Federal Funds**: Enter total
funding not requested from FIPSE by partner institutions.

**19a. Total Requested from Canada:** Leave Blank.

**19b. Total Requested from Mexico:** Leave Blank.

**19c. Total Requested from Brazil:** Enter the dollar amount requested
by Brazilian partners.

**19d. Total Requested from Europe:** Leave Blank.

**Indirect Cost Information**:

If you are requesting reimbursement for indirect costs on line 12, this
information is to be completed by your Business Office. (1): Indicate
whether or not your organization has an Indirect Cost Rate Agreement
that was approved by the federal government. (2): If you checked "yes"
in (1), indicate in (2) the beginning and ending dates covered by the
Indirect Cost Rate Agreement. In addition, indicate whether ED or
another federal agency (Other) issued the approved agreement. If you
check "Other," specify the name of the federal agency that issued the
approved agreement. (3): If you are applying for a grant under a
Restricted Rate Program (34 CFR 75.563 or 76.563), indicate whether you
are using a restricted indirect cost rate that is included on your
approved Indirect Cost Rate Agreement or whether you are using a
restricted indirect cost rate that complies with 34 CFR 76.564(c)(2).
Note: State or local government agencies may not use the provision for a
restricted indirect cost rate specified in 34 CFR 76.564(c)(2). Check
only one response. Leave blank, if this item is not applicable.

Instructions for Completing the ED FIPSE Consortium Partners
Identification Form

When completing the Consortium Partners Identification forms, it is
essential that you list *[both the lead and partner institutions for
each country before moving back to the application
package.]{.underline}* The consortia identification forms serve as
identification for all U.S. and foreign partners involved in your
consortium.

You are required to complete the original form for both the Lead Partner
and Partner Two, and one extracted copy. IF YOU DO NOT COMPLETE ALL
REQUIRED INFORMATION YOUR APPLICATION WILL NOT BE SUBMITTED PROPERLY AND
WILL BE REJECTED BY GRANTS.GOV.

STEPS FOR COMPLETING THE CONSORTIUM PARTNERS IDENTIFICATION FORM:

1.  Enter all information on the first page for lead partner (lead U.S.
    institution).

2.  Select "Next" at the top of the page

3.  Enter all information for Partner Two (U.S. partner institution)

4.  Select "Next" at the top of the page

5.  Do not fill out any information for Partner Three, simply select
    "Next" at the top of the page.

6.  On this page you are required to extract a new form and complete it
    for the lead foreign partner and partner two for Brazil. To extract
    the form select the button "Select to extract the Consortium
    Partners Identification Form Attachment."

7.  Save the extracted file (blank copy of the original form) to your
    computer.

8.  Using the extracted file you saved enter all information on the
    first page for lead Brazilian partner.

9.  Select "Next" at the top of the page

10. Enter all information for Partner Two (Brazilian partner
    institution)

11. Select "Next" at the top of the page

12. Do not fill out any information for Partner Three, simply select
    "Next" at the top of the page.

13. Save the completed document to your computer.

14. Return to the original form where you "extracted" the copy and
    attach the copy you completed for the Brazilian partner under
    "Please Attach Attachment 1" using the "Add Attachment" button.

PLEASE NOTE: In order to complete these forms correctly you must extract
and complete a copy of the form. When extracting a form you are
basically saving a clean copy of the pure edge form to your computer,
completing that form and reattaching it to the pure edge application.
Reminder: To extract a form, fill out the original form, select the
"NEXT" button at the top of the page until you reach a button that says
"Select to extract the Consortium Partners Identification Form
Attachment." Select that button; you will be prompted to save a copy of
the form onto your computer; complete that form and attach it to the
page where you selected to extract the attachment. To attach the
extracted form you must select "Add Attachment" on the page where you
extracted the form and select the form you completed and saved on your
computer.