> Form No.: ED 40-736
>
> OMB NO.: 1840-0736
>
> Form Expires: 5/31/2002

# Archived Information

**LEARNING ANYTIME ANYWHERE PARTNERSHIPS (LAAP)**

**FUND FOR THE IMPROVEMENT OF POSTSECONDARY EDUCATION**

**TITLE PAGE**

**This Application should be sent to:** 1. Application Number:

No. 84.339

U.S. Department of Education 2. D-U-N-S Number:

Application Control Center

Room 3633 3. Tax Identification Number:

Washington, D.C. 20202-4725

4\. Project Director (Name and Complete Mailing Address): 5. List of
Partners:

Telephone:

Fax:

E-mail:

6\. Federal Funds Requested: 7. Total Cost Share Provided:

1st Year only: 8. Duration of Project:

2nd Year (if applicable):

3rd Year (if applicable): Starting Date:

4th Year (if applicable):

> Ending Date:

Total Amount: Total No. of Months:

9\. Proposal Title:

10\. Brief Abstract of Proposal (DO NOT LEAVE THIS BLANK):

11\. Legal Applicant (Name & Complete Mailing Address): 12. (Final
Proposals only) Are there any research activities involving human
subjects planned at any time during the proposed project period?

\_\_\_\_\_\_\_Yes \_\_\_\_\_\_\_No

If yes, then please follow the instructions on following page.

13\. Certification by Authorizing Official:

The applicant certifies to the best of his/her knowledge and belief that
the data in this application are true and correct, that the filing of
the application has been duly authorized by the governing body of the
applicant, and that the applicant will comply with the attached
assurances if assistance is approved.

Print Name Title Phone

Signature Date

**Instructions for Completing Title Page (Form ED 40-736)**

**Specific Instructions**

**Please Note:** Complete Items 1,2, and the Congressional District in
Item 10 only at the final proposal stage. However, do complete the rest
of Item 10 at the preliminary proposal stage.

**Item 1. Application Number:** Enter the Proposal Reference Number
assigned to your preliminary proposal.

**Item 2. D-U-N-S Number:** Beginning in FY 1998, the 9-digit D-U-N-S
Number replaced the 12-digit Employer Identification Number (EIN) used
in previous years. The D-U-N-S Number is assigned to organizations by
Dun & Bradstreet. If you do not know your D-U-N-S Number, call the
toll-free telephone number maintained by Dun & Bradstreet: 800-333-0505
(Monday - Friday, 8:30 a.m. - 6:00 p.m. Eastern time).

**Item 3: Tax Identification Number (TIN):** Enter the tax
identification number as assigned by the Internal Revenue Service.

**Item 4. Project Director:** Enter the name and complete mailing
address of the designated Project Director. If no one has been selected,
so indicate and enter the name of the person who can be contacted to
discuss the programmatic aspects of the project. NOTE: Name and address
listed here will be used to mail proposal status notifications. Do not
forget to include the telephone number. Both this address and the Legal
Applicant address (Item 9) should be fully completed.

**Item 5. Institutional Information:** List each participating member of
the partnership.

**Item 6. Federal Funds Requested:** Enter the amount of Federal funds
being requested from FIPSE in the first year of the project. If
applicable, enter the amount requested for subsequent years of funding.
Under total enter the cumulative amount requested for the life of the
project.

**Item 7. Total Cost Share Provided:** Enter the total amount of
matching funds for the duration of project (must equal at least 50% of
the total cost of the project).

**Item 8. Duration of Project:** Enter the beginning date of the project
(no earlier than September 1, 2001). Enter the ending date and the total
number of months covered.

**Item 9. Proposal Title:** Self-explanatory.

**Item 10. Brief Abstract of Proposal:** Complete for both preliminary
and final proposals. This should be concise and confined to the space
provided, but in no case should you leave this space blank. For final
proposals, also see instructions under submission procedures
requesting a separate one-page abstract.

**Item 11. Legal Applicant:** Enter the name and complete mailing
address of the non-profit institution or organization which will serve
as the legal applicant (fiscal agent). When more than one institution or
agency is involved, enter the name of the one which will be responsible
for budget control. Official notifications of grant awards are sent to
this address. Remember to complete this section fully.

**Item 12. Human Subjects. (Final Proposals Only)** Check "Yes"
**[or]{.underline}** "No" If research activities involving human
subjects are not planned at any time during the proposed project period,
check "No." If research activities involving human subjects, whether or
not exempt from Federal regulations for the protection of human
subjects, **[are]{.underline}** planned **[at any time]{.underline}**
during the proposed project period, either at the applicant organization
or at any other performance site or collaborating institution, check
**"Yes"** and complete the following**:**

> a\. If "Yes," Exemption (s)#: b. Assurance of Compliance #:
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ OR
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> c\. IRB approval date: \_\_\_\_\_\_\_ Full IRB [or]{.underline}
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_ Expedited
> Review

If **[all]{.underline}** the research activities are designated to be
exempt under the regulations, enter above, in item 12a, the exemption
number(s) corresponding to one or more of the six exemption categories
listed in **"Protection of Human Subjects in Research"** attached to
this form. Provide sufficient information in the application to allow a
determination that the designated exemptions in item 12a, are
appropriate. **Provide this narrative information in an "Item
12/Protection of Human Subjects Attachment" and insert this attachment
immediately following the title page. Skip the remaining parts of item
12.**

If **[some or all]{.underline}** of the planned research activities
involving human subjects are covered (nonexempt), skip item 12a and
continue with the remaining parts of item 12, as noted below. In
addition, follow the instructions in **"Protection of Human Subjects in
Research** (available as part of ED 424 on the web at
<http://www.ed.gov/about/offices/list/ocfo/humansub.html>) to prepare
the six-point narrative about the nonexempt activities. **Provide this
six-point** **narrative in an "Item 12/Protection of Human Subjects
Attachment" and insert this attachment immediately following the title
page.**

**If the applicant organization has an approved Multiple Project
Assurance of Compliance** on file with the Grants Policy and Oversight
Staff (GPOS), U.S. Department of Education, or with the Office for
Protection from Research Risks (OPRR), National Institutes of Health,
U.S. Department of Health and Human Services, that covers the specific
activity, enter the Assurance number in item 12b and the date of
approval by the Institutional Review Board (IRB) of the proposed
activities in item 12c. This date must be no earlier than one year
before the receipt date for which the application is submitted and must
include the four (4) digit year (e.g., 2000). Check the type of IRB
review in the appropriate box. An IRB may use the expedited review
procedure if it complies with the requirements of 34 CFR 97.110. If the
IRB review is delayed beyond the submission of the application, enter
**"Pending"** in item 12c. If your application is recommended/selected
for funding, a follow-up certification of IRB approval from an official
signing for the applicant organization must be sent to and received by
the designated ED official within 30 days after a specific formal
request from the designated ED official. **If the applicant organization
does not have** on file with GPOS or OPRR **an approved Assurance of
Compliance** that covers the proposed research activity, enter
**"None"** in item 12b and skip 12c. In this case, the applicant
organization, by the signature on the application, is declaring that it
will comply with 34 CFR 97 within 30 days after a specific formal
request from the designated ED official for the Assurance(s) and IRB
certifications.

**Item 13. Certification by Authorizing Official:** Enter the name,
title, and telephone number of the official who has the authority to
commit the organization to accept Federal funding and to execute the
proposed project. Submit the original ink-signed copy of the authorizing
officials signature.