**UNITED STATES DEPARTMENT OF EDUCATION**

**WASHINGTON, D.C. 20202**

**APPLICATION FOR DESIGNATION AS AN ELIGIBLE INSTITUTION**

**FISCAL YEAR 2008**

CFDA Number: 031H

To apply for grants under Title III, Part A, Title V,

CCRAA-HSI, and CCRAA-AANAPISI Programs

Authority: 34 CFR Part 606 and 607 Programs

## Important: You are required to provide the information requested

**in order to obtain or retain a benefit.**

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 1840-0103. The time required
to complete this information collection is estimated to average 7.00
hours (or 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 time estimate(s) or suggestions
for improving this form, please write to: U.S. Department of Education,
Washington, D.C. 20202-4561. If you have comments or concerns regarding
the status of your individual submission for this form, write directly
to: Institutional Development and Undergraduate Education Service, U.S.
Department of Education, 600 Independence Avenue, S.W., (1990 K Street,
N.W., 6th Floor), Washington, DC 20202-8513.

**\* This form must be completed electronically.**

# Part I. Identity of Applicant Institution

1\. Institution/Campus OPE ID Number:

2\. Name of Institution/Campus Requesting:

3\. Address (Street \# or P.O. Box and Street Name, City, State, Zip):

4\. Contact Person's Name: (Last Name, First Name, Middle Initial):

5\. Contact Person's Title, Phone Number, Extension:

6\. E-mail Address:

7\. Data Universal Numbering System (DUNS Number):

8\. Type (mark one): ( ) 2-Year Institution ( ) 4-Year Institution

9\. Control (mark one): ( ) Private Non-Profit Institution ( ) Public
Institution

# Part II. Institutional Enrollment

1\. Total Institutional Enrollment (Fall 2005 Head Count):

2\. Total Minority Enrollment (Fall 2005 Head Count):

# Part III. Institutional Statistics

1\. Needy Student Requirement

> A. Fall 2005 Head Count Enrollment of Undergraduate and Graduate
> Degree Students:
>
> B. Fall 2005 Recipients of Title IV Need-Based Financial Assistance:
>
> (Include Only Pell Grant, Supplemental Educational Opportunity Grant,
> College Work Study, and Perkins Loan)
>
> C. Fall 2005 Enrollment of Half-Time up to and including Full-Time
> Undergraduate Students:
>
> D. Fall 2005 Pell Grant Recipients:

**2. Educational & General Expenditures Requirement (E&G)**

> A. Undergraduate Full-Time Equivalent Fall 2005 Enrollment
>
> a\. Total Full-Time Undergraduate Students:
>
> b\. Total Number of Credit Hours for all Part-Time Undergraduate
> Students:
>
> B. Graduate Full-Time Equivalent Fall 2005 Enrollment:
>
> a\. Total Full-Time Graduate Students:
>
> b\. Total Number of Credit Hours for all Part-Time Graduate Students:
>
> C. Total 2005-2006 Educational & General Expenditures (E&G):
>
> D. Average 2005-2006 E&G per FTE = C/(A+B):

Part IV. Specific Institutional Eligibility Requirements

1\. Needy Student Requirement (mark A, B. or C)

> ( ) A. According to the result, after dividing item 1B by item 1A in
> Part III of this form, at least 50% of Degree Students are recipients
> of Need-Based Financial Support; or
>
> ( ) B. According to the result, after dividing item 1D by item 1C in
> Part III of this form, our enrollment exceeds the pertinent threshold
> for Substantial Percentage of Students Receiving Pell Grants for the
> 2005-2006 year.
>
> ( ) C. Requesting Waiver (Section 607.3(b) and Section 606.3(b)
> option(s):
>
> Fill in the bubble(s) needed and attach the narrative justification to
> this form.

AND

2\. Educational & General Expenditures Requirement (mark A or B)

> ( ) A. The E&G expenditures per FTE Student are less than the
> pertinent threshold for base year 2005-2006.
>
> ( ) B. Requesting Waiver (Section 607.4(c) and (d) and Section
> 606.4(c) and (d) option(s):
>
> Fill in the bubble(s) needed and attach the narrative justification to
> this form.

Part V. Certification

(Although this Certification requirement is waived for applicants
submitting through the Internet,

the Department reserves the right to require a signed form on request.)

To the best of my knowledge and belief, all data in this application are
true and correct. The governing body of the applicant has duly
authorized this document and the applicant will comply with the required
assurances. We meet the accrediting requirements and, if applicable, we
meet the definition of a branch campus as defined in 34 CFR Part
606.7(b) and 34 CFR 607.7(e).

Authorized Representative\'s Typed Name and Title Date Authorized
Representative\'s Signature

Phone Number Fax Number Former Name of Applicant Institution/Campus (if
applicable)

Form Approved - OMB No. 1340-0103

ED Form 1049 (Revised 11/99), Replaces ED Form 1049, Revised 8/95 which
is obsolete.

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