**DRAFT**

**U. S. DEPARTMENT OF EDUCATION**

Office of Postsecondary Education

Washington, DC 20006-8510

![](media/image1.png){width="1.975in" height="1.8027777777777778in"}

**APPLICATION FOR GRANTS UNDER THE**

**STRENGTHENING INSTITUTIONS PROGRAM**

**CFDA \# 84.031A**

**AMERICAN INDIAN TRIBALLY CONTROLLED**

**COLLEGES AND UNIVERSITIES PROGRAM**

**CFDA \# 84.031T**

**ALASKA NATIVE-SERVING INSTITUTIONS PROGRAM**

**CFDA \# 84.031N**

**AND THE**

**NATIVE HAWAIIAN-SERVING INSTITUTIONS PROGRAM**

**CFDA \# 84.031W**

**Form Approved**

**OMB No. 1840 - 0114, Exp. Date:**

**CLOSING DATE: TBD**

TABLE OF CONTENTS

Page

Dear Applicant Letter

Highlights of Key Changes

Grants.gov Submission Procedures

Instructions for Transmitting Applications

Planning Grant Applications

Individual and Cooperative Arrangement Development

Grant Applications

TCCU Construction and ANNH Renovation Grant Applications

Federal Register Notice

Executive Order 12372

State Single Points of Contact

General Education Provisions Act (GEPA) Section 427

Government Performance and Results Act (GPRA)

Instructions for Completing the Application Package

> SF 424
>
> Education Supplement to the SF 424
>
> ED 524 (Budget Form)
>
> SF-LLL

Application Checklist

Required Forms

-   Application for Federal Education Assistance (A separate SF 424 for
    each type of application)

-   Department of Education Supplement to the SF 424

-   ED Form 524 (All applicants)

-   ED Abstract Form

-   Project Narrative Attachment Form

-   Other Attachments Form

-   ED GEPA 427 Form -- General Education Provisions Act Section 427
    Requirements

-   Standard Form 424B (All applicants)

-   Grants.gov Lobbying Form (formerly the ED 80-0013) (All applicants)

-   ED 80-0014 (if applicable)

-   SF-LLL (if applicable)

-   Survey on Ensuring Equal Opportunity for Applicants (voluntary
    submission)

Dear Applicant:

Thank you for your interest in applying for a grant under Title III,
Part A, of the Higher Education Act of 1965, as amended. The programs
are collectively referred to as the Title III, Part A programs. They are
the Strengthening Institutions Program (SIP), the American Indian
Tribally Controlled Colleges and Universities (TCCU) Program, and the
Alaska Native and Native Hawaiian-Serving Institutions (ANNH) Program.
The overall purpose of these programs is to provide grants to eligible
institutions of higher education to enable them to improve their
academic quality, institutional management, and fiscal stability in
order to increase their self-sufficiency and strengthen their capacity
to make a substantial contribution to the higher education resources of
the Nation.

To receive a grant under Title III, Part A, an institution of higher
education must have applied for and received designation as an eligible
institution. The Notice Inviting Fiscal Year (FY) 2006 applications to
[Request Designation As An Eligible Institution Under The Title III,
Part A Programs]{.underline} was published in the [Federal]{.underline}
[Register]{.underline} on December 16, 2005. The deadline date for
receipt of that application is February 24, 2006*.* The
[Federal]{.underline} [Register]{.underline} Notice inviting
applications for new awards and application instructions is included in
this package.

The Department requires applicants to use an Internet-based electronic
system for submitting applications. We are requiring that applications
for FY 2006 grants under these programs be submitted electronically
using the Grants.gov Apply site (Grants.gov). You are urged to acquaint
yourself with the requirements of Grants.gov early. A more thorough
discussion is included in this application package. Grants.gov is
accessible through its portal page at:

[http://www.grants.gov](http://www.grants.gov/)

For information (including dates and times) about how to submit your
application electronically please refer to the official Notice Inviting
Applications for New Awards for FY 2006 published in the
[Federal]{.underline} [Register]{.underline}.

You are reminded that you should not rely upon any information that is
inconsistent with the guidance contained within this application
package. I urge you to carefully read all the information contained in
this package, including the eligibility requirements found in Sections
316 and 317 of the HEA, before preparing your application.

[]{.mark}

> Sincerely,
>
> James Manning
>
> Acting Assistant Secretary

Office of Postsecondary Education Programs

#### Highlights of Key Changes

1\. **SIP applications must be submitted electronically using
Grants.gov** unless you qualify for one of the exceptions to the
electronic submission requirement. The requirements for obtaining an
exception to the electronic submission have changed. If you think you
may need an exception you are urged to review the requirements promptly.

2\. **Applications submitted late will not be accepted**. The Department
of Education (Department) is required to enforce the established
deadline to ensure fairness to all applicants. No changes or additions
to an application will be accepted after the deadline date. Please note
that Grants.gov does not allow applicant's to "un-submit" applications.
If you discover that changes or additions are needed once your
application has been accepted and validated by the Department, you must
"re-submit" the application. You should know that if the Department
receives duplicate applications, we will accept and process the
application with the latest "date/time received" validation. Go to the
Grants.gov portal page for more information:
[**http://www.grants.gov**](http://www.grants.gov/)

3\. **Applications must follow specific formatting requirements**. A
"page" is 8.5" x 11", on one side only, with 1" margins at the top,
bottom, and both sides. Page numbers and an identifier may be within the
1" margin. Double space (no more than three lines per vertical inch) all
text in the application narrative, [except]{.underline} titles,
headings, footnotes, quotations, references, captions and all text in
charts, tables, and graphs. Use one of the following fonts: Times New
Roman, Courier, Courier New, or Arial. Applications submitted in any
other font (including Times Roman and Arial Narrow) will be rejected.
Use not less than 12-point font.

4\. **Applicants are required to submit a Program Abstract as well as a
Program Profile page.** Information provided in the Program Abstract is
limited to one double-spaced page and must be uploaded into the "ED
Abstract Form" in the Grants.gov application package. Applicants are
also required to copy and paste the Program Profile into a separate
document or recreate the form exactly as it appears, and attach the form
to the "Other Attachment Form" as either a .doc, .rtf or .pdf document.

Applicants are asked to carefully read question #4 on the Program
Profile, and check the box or place an X next to the box certifying that
they will comply with the statutory requirements and program assurances
cited in the program regulations.

**IMPORTANT -- PLEASE READ FIRST**

**U.S. Department of Education**

***[Grants.gov Submission Procedures and Tips for
Applicants]{.underline}***

Please note that the Grants.gov site works differently than the U.S.
Department of Education's (Department) e-Application system. To
facilitate your use of Grants.gov, this document includes important
submission procedures you need to be aware of to ensure your application
is received in a timely manner and accepted by the Department.

1)  **REGISTER EARLY** -- Grants.gov registration is a one-time process
    that may take five or more days to complete. You may begin working
    on your application while completing the registration process, but
    you cannot submit an application until all of the Get Started steps
    are complete. For detailed information on the Get Started Steps,
    please go to: <http://www.grants.gov/GetStarted>.

2)  **SUBMIT EARLY** -- **We strongly recommend that you do not wait
    until the last day to submit your application. Grants.gov will put a
    date/time stamp on your application and then process it after it is
    fully uploaded.** The time it takes to upload an application will
    vary depending on a number of factors, including the size of the
    application, speed of your Internet connection, and the time it
    takes Grants.gov to process the application. If Grants.gov rejects
    your application (see step three below), you will need to resubmit
    successfully before 4:30 p.m. on the deadline date.

> **Note: To submit successfully, you must provide the DUNS number on
> your application that was used when your organization registered with
> the CCR (Central Contractor Registry).**

3)  **VERIFY SUBMISSION IS OK** -- You will want to verify that
    Grants.gov and the Department received your Grants.gov submission
    timely and that it was validated successfully. To see the date/time
    your application was received, login to Grants.gov and click on the
    Check Application Status link. For a successful submission, the
    date/time received should be earlier than 4:30 p.m. on the deadline
    date, AND the application status should be: Validated, Received by
    Agency, or Agency Tracking Number Assigned.

> If the date/time received is later than 4:30 p.m. Washington, D.C.
> time, on the closing date, your application is late. If your
> application has a status of "Received" it is still awaiting validation
> by Grants.gov. Once validation is complete, the status will either
> change to "Validated" or "Rejected with Errors." If the status is
> "Rejected with Errors," your application has not been received
> successfully. Some of the reasons Grants.gov may reject an application
> can be found on the Grants.gov site:
> <http://www.grants.gov/assets/ApplicationErrorTips.doc>. If you
> discover your application is late or has been rejected, please see the
> instructions below. Note: You will receive a series of confirmations
> both online and via e-mail about the status of your application.
> Please do not rely solely on e-mail to confirm whether your
> application has been received timely and validated successfully.

# Submission Problems -- What should you do?

If you have problems submitting to Grants.gov before the closing date,
please contact Grants.gov Customer Support at 1-800-518-4726 or use the
customer support available on the Web site:
<http://www.grants.gov/CustomerSupport>.

If electronic submission is [optional]{.underline} and you have problems
that you are unable to resolve before the deadline date and time for
electronic applications, please follow the transmittal instructions for
hard copy applications in the [Federal]{.underline}
[Register]{.underline} notice and get a hard copy application postmarked
by midnight on the deadline date.

If electronic submission is [required]{.underline}, you must submit an
electronic application before 4:30 p.m., unless you follow the
procedures in the [Federal]{.underline} [Register]{.underline} notice
and qualify for one of the exceptions to the electronic submission
requirement [and]{.underline} submit, no later than two weeks before the
application deadline date, a written statement to the Department that
you qualify for one of these exceptions. (See the [Federal]{.underline}
[Register]{.underline} notice for detailed instructions.)

# 

# Helpful Hints When Working with Grants.gov

Please note, once you download an application from Grants.gov, you will
be working offline and saving data on your computer. Please be sure to
note where you are saving the Grants.gov file on your computer. You will
need to logon to Grants.gov to upload and submit the application. (This
is different from e-Application, where you are working online and saving
data to the Department's database.) **REMEMBER, you must provide on your
application the exact same DUNS number that was used when your
organization registered with the CCR.**

Please go to <http://www.grants.gov/ForApplicants> for help with
Grants.gov and click on the links in the lower right corner of the
screen under Applicant Tips and Tools. For additional tips related to
submitting grant applications, please refer to the Grants.gov Submit
Application Tips found on the Grants.gov homepage
[http://www.grants.gov](http://www.grants.gov/).

# 

# Dial-Up Internet Connections

When using a dial up connection to upload and submit your application,
it can take significantly longer than when you are connected to the
Internet with a high-speed connection, e.g. cable modem/DSL/T1. While
times will vary depending upon the size of your application, it can take
a few minutes to a few hours to complete your grant submission using a
dial up connection. **If you do not have access to a high-speed
connection and electronic submission is required, you may want to
consider following the instructions in the [Federal]{.underline}
[Register]{.underline} notice to obtain an exception to the electronic
submission requirement no later than two weeks before the application
deadline date.** (See the [Federal]{.underline} [Register]{.underline}
notice for detailed instructions.)

# 

# MAC Users

If you do not have a Windows Operating System, you will need to use a
Windows Emulation program to submit an application using Grants.gov. For
additional information, review the [PureEdge Support for
Macintosh](http://www.grants.gov/GrantsGov_UST_Grantee/!SSL!/WebHelp/MacSupportforPureEdge.pdf)
white paper published by Pure Edge:
<http://www.grants.gov/GrantsGov_UST_Grantee/!SSL!/WebHelp/MacSupportforPureEdge.pdf>,
and/or contact Grants.gov Customer Support
(<http://www.grants.gov/CustomerSupport>) for more information. **If you
do not have a Windows emulation program and electronic submission is
required, please follow instructions in the [Federal]{.underline}
[Register]{.underline} notice to obtain an exception to the electronic
submission requirement no later than two weeks before the application
deadline date.** (See the [Federal]{.underline} [Register]{.underline}
notice for detailed instructions.)

INSTRUCTIONS FOR TRANSMITTING APPLICATIONS

##### **ATTENTION ELECTRONIC APPLICANTS: Please note that you must follow the Application Procedures as described in the [Federal]{.underline} [Register]{.underline} notice announcing the grant competition.** 

##### 

##### **This program requires the electronic submission of applications. Specific requirements and instructions can be found in the [Federal]{.underline} [Register]{.underline} notice.** 

If you want to apply for a grant and be considered for funding, you must
meet the following deadline requirements:

### **[Applications Submitted Electronically]{.underline}**

You must submit your grant application through the Internet using the
software provided on the Grants.gov Web site
([http://www.grants.gov](http://www.grants.gov/)) by 4:30 p.m.
(Washington, D.C. time) on the application deadline date. If you submit
your application through the Internet via the Grants.gov Web site, you
will receive an automatic acknowledgment when we receive your
application.

For more information on using Grants.gov, please refer to the Notice
Inviting Applications that was published in the Federal Register, the
Grants.gov Submission Procedures and Tips document found in the
application package instructions, and visit http://www.grants.gov.

**According to the instructions found in the [Federal]{.underline}
[Register]{.underline} notice those requesting and qualifying for an
exception to the electronic submission requirement may submit an
application via mail, commercial carrier or by hand delivery.**

### 

### [Applications Sent by Mail]{.underline} 

You must mail the original and two copies of the application on or
before the deadline date to:

## **U.S. Department of Education** 

**Application Control Center**

> **Attention: CFDA# (84.031A; 84.031T; 84.031N; [or]{.underline}
> 84.031W)**
>
> **400 Maryland Avenue, S.W.**
>
> **Washington, DC 20202 - 4260**

You must show one of the following as proof of mailing:

(1) A legibly dated U. S. Postal Service Postmark.

(2) A legible mail receipt with the date of mailing stamped by the U. S.
    Postal Service.

(3) A dated shipping label, invoice, or receipt from a commercial
    carrier.

(4) Any other proof of mailing acceptable to the Secretary.

If you mail an application through the U.S. Postal Service, we do not
accept either of the following as proof of mailing:

\(1\) A private metered postmark.

(2) A mail receipt that is not dated by the U.S. Postal Services.

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

[Applications Delivered by Commercial Carrier]{.underline}:

Applications that are delivered by commercial carrier, such as Federal
Express, United Parcel Service, etc. should be mailed to the:

> **U.S. Department of Education**

#####  **Application Control Center -- Stop 4260** 

> **Attention: CFDA# (84.031A; 84.031T; 84.031N; [or]{.underline}
> 84.031W)**
>
> **7100 Old Landover Road**
>
> **Landover, MD 20785-1506**

### 

### [Applications Delivered by Hand]{.underline}

You or your courier must hand deliver the original and number of copies
requested of the application by 4:30 p.m. (Washington, D.C. time) on or
before the deadline date. To help expedite our review of your
application, we would appreciate your voluntarily including an
additional three copies of your application.

Please hand deliver copies to:

> **U.S. Department of Education**
>
> **Application Control Center**
>
> **Attention: CFDA# (84.031A; 84.031T; 84.031N; [or]{.underline}
> 84.031W)**
>
> **550 12^th^ Street, S.W.**
>
> **PCP - Room 7041**

#####  **Washington, DC 20202-- 4260**

The Application Control Center accepts application deliveries daily
between 8:00 a.m. and 4:30 p.m. (Washington, D.C. time), except
Saturdays, Sundays and federal holidays.

**PLANNING GRANT APPLICATIONS**

This section provides you with information critical to your successful
completion and submission of a one-year **Planning Grant** application.
You may apply for a Planning Grant only as an individual institution \--
not as part of a cooperative arrangement of multiple institutions.

When developing your application, be sure to:

-   Address the selection criteria (34 CFR §607.21) as precisely as
    possible, and in the same order as they appear in this application
    package, to ensure your application contains the information readers
    will need to judge the quality of the proposed planning project.

```{=html}
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```
-   Describe, as concisely and accurately as possible, the planning
    process that your institution will use to prepare a Comprehensive
    Development Plan (CDP) and the remaining parts of a development
    grant application.

Your Planning Grant application must contain the following:

1.  **Application for Federal Assistance (SF 424)**

> Use the Application for Federal Assistance (SF 424) as the official
> request for Title III funding. This form is accessible on-line using
> our Grants.gov system. A copy of that form is also included in this
> package for your review. Be sure to download the correct application
> (by CFDA number) and to specify, on the SF 424, which type of grant
> you are applying for.

**2. Department of Education Supplemental Information Form for the SF
424**

**3. Program Profile Page (To be attached to the "Other Narrative
Attachment**

**Form").** This form is used to profile you, the applicant. It also
addresses endowment funding, dual submission certification and
cooperative arrangements.

**4. Selection Criteria - Program Narrative Attachment**

> ***Content:*** This is the narrative portion of your application where
> you address the weighted selection criteria that the readers will use
> to evaluate your application and to assess the strengths and
> weaknesses of your proposal. These pages will be included in the
> mandatory page count.
>
> Be sure to include a Table of Contents. The Table of Contents will
> [not be included in the page count.]{.underline} Prepare your complete
> program narrative in a .doc, .rtf, or .pdf format and attach it to the
> "Project Narrative Attachment Form" in the application package
> downloaded from Grants.gov.
>
> **(a) Design of the Planning Process**
>
> **(1)** The extent to which the planning process is clearly and
> comprehensively described and based on sound planning practice.
>
> ***Content:*** Comprehensively describe the planning process \-- a
> series of actions or steps \-- that you will use to develop the CDP
> and the rest of the development grant application.
>
> **(2)** The extent to which the president or chief executive officer,
> administrators and other institutional personnel, students, and
> governing board members systemically and consistently will be involved
> in the planning process.
>
> ***Content:*** Describe how your institution will involve,
> systematically and consistently, the president or chief executive
> officer, administrators, faculty, staff, students, and governing board
> members in pertinent phases of the planning process.
>
> **(3)** The extent to which the applicant will use its own resources
> to help implement the project.
>
> ***Content*:** Describe your institution's resources, including
> personnel, facilities, monies, or the like, that you will use to carry
> out the planning process successfully.
>
> **(4)** The extent to which the planning process is likely to achieve
> its intended results.
>
> ***Content:*** Explain your rationale for using this process by
> showing that it is based on sound state-of-the-art planning practice
> and is likely to achieve its intended results.
>
> **(b) Key** **Personnel**
>
> **(1)** The extent to which the past experience and training of key
> personnel such as the project coordinator and persons who have key
> roles in the planning process are suitable to the tasks to be
> performed.
>
> **(2)** The extent to which the time commitments of key personnel are
> adequate.

######### 

> ***Content:*** Identify, by title, the key personnel who will perform
> the project tasks.
>
> Provide a **position description or resume** for each key position
> that the grant will support. Describe the qualifications that you will
> require for the positions and the amount of time each person will
> allot to the project. If you want to use a consultant, include a
> position description and explain why a consultant is more advantageous
> than using the institution's personnel.
>
> **(c) Project Management Plan**

**(1)** The extent to which the procedures for managing the project are
likely to ensure effective and efficient project implementation.

**(2)** The extent to which the project coordinator has sufficient
authority, including access to the president or chief executive officer,
to conduct the project effectively.

***Content:*** Describe the procedures you will use to:

-   Manage, facilitate and monitor the planning process,

-   Formulate the CDP, and

-   Prepare the rest of the development grant application.

Include provisions for gathering and reporting project information to
appropriate decision-makers at your institution. Also, provide evidence
that the project coordinator will have sufficient administrative
authority, including access to the president or chief executive officer,
to conduct the project effectively.

**(d) Budget (This selection criteria must be included in the program
narrative document attached to the "Project Narrative Attachment.")**

**(1)** Prepare a detailed budget narrative for the planning activity.
Demonstrate and justify that all costs are reasonable in today's market
and necessary to accomplish your activity objectives. Include a
discussion of the major costs to be covered by the grant funds.

***Content:*** Your budget should correspond to your institution\'s
needs for goods and services, as described in the program narrative, and
should reflect costs that are allowable and reasonable.

> **NOTE: The Title III, Part A, Strengthening Institutions Programs,
> CFDA 84.031A, T, N, and W) do not reimburse grantees for indirect
> costs they incur in carrying out a project funded under these
> programs. Therefore, applicants should not show any dollar amounts for
> indirect costs on either line 10 of the application budget form (ED
> 524) or in their budget narrative. Applicants should also be aware
> that un-reimbursed indirect costs under grants of this program may not
> be charged as direct cost items in the same award, used to satisfy
> matching or cost-sharing requirements, or charged to another Federal
> award.**

**5. U. S. Department of Education Budget Information Non-Construction
Programs (Section A - Budget Summary U.S. Department of Education Funds
and Section B -- Budget Summary Non-Federal Funds (ED 524 form)).**

> First, carefully read the instructions contained in this document.
> Then, using the Dept of Education Budget Information for
> Non-Construction Programs (ED524) form, prepare a budget for the
> entire project that totals all the costs for the grant

**6. Required Assurances and Certifications**

All applicants must submit these forms electronically, as a part of your
application.

-   Assurances -- Non-Construction Programs (SF 424-B)

-   Grants.gov Lobbying Form (formerly the ED 80-0013 form)

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

-   Disclosure of Lobbying Activities (SF -- LLL)

-   ED GEPA 427 Form - General Education Provisions Act Section 427
    Requirements. Please refer to the GEPA 427 requirements outlined in
    the "Notice to All Applicants" for instructions on completing this
    statement

-   Survey on Ensuring Equal Opportunity for Applicants (OMB No.
    1890-0014) \[voluntary submission\]

> Carefully read the instructions for each form and be sure to provide
> all the requested information.

**DEVELOPMENT GRANT APPLICATIONS**

**(Individual and Cooperative Arrangements)**

This section provides you with information critical to your successful
completion and submission of a five-year **Individual Development** or
**Cooperative Arrangement** **Development** **Grant** application.

When developing your application, be sure to address the selection
criteria (34 CFR §607.22(b)-(g)) **separately for [each]{.underline}
proposed activity,** as precisely as possible to ensure your application
contains the information readers will need to judge the quality of the
proposed development project.

Your development grant application (individual or cooperative
arrangement) must contain the following:

**1. Application for Federal Assistance (SF 424)**

> Use the Application for Federal Assistance (SF 424) as the official
> request for Title III funding. This form is accessible on-line using
> our Grants.gov system. A copy of that form is also included in this
> package for your review. Be sure to download the correct application
> (by CFDA number) and to specify, on the SF 424, which type of grant
> (planning, individual development, cooperative arrangement
> development, construction, or renovation) for which you are applying.

**2. Department of Education Supplemental Information Form for the SF
424**

**3. ED Abstract Form**

**4. Program Profile Page (To be attached to the "Other Narrative
Attachment Form").** This form is used to profile you, the applicant. It
also addresses endowment funding, dual submission certification and
cooperative arrangements.

**5. Selection Criteria - Program Narrative Attachment**

> **As part of addressing the selection criteria and developing the
> Comprehensive Development Plan (CDP), we presume that your institution
> has analyzed the major problems affecting it, and designed specific
> strategies to address and possibly resolve these problems. You should
> be ready to carry out the proposed project once you receive the grant
> and should not use the funds for intensive planning activities.**
>
> Be sure to include a Table of Contents. The Table of Contents will
> [not be included in the page count.]{.underline} Prepare your complete
> program narrative in a .doc, .rtf, or .pdf format and attach it to the
> "Project Narrative Attachment Form" in the application package
> downloaded from Grants.gov.
>
> ***Content:*** This is the narrative portion of your application where
> you address the weighted selection criteria that the readers will use
> to evaluate your application and to assess the strengths and
> weaknesses of your proposal. **These pages will be included in the
> mandatory page count.**
>
> **For [each]{.underline} proposed activity**, separately address the
> selection criteria ((b) through (g)), in the same order as they appear
> below and as precisely as possible, to ensure your application
> contains the information readers will need to judge the quality of the
> proposed development (individual or cooperative arrangement) grant
> activities.
>
> Title each activity so that the reader readily knows your focus. The
> HEA lists the allowable activities for the Strengthening Institutions
> Program, the American Indian Tribally Controlled Colleges and
> Universities Program, the Alaska Native- Serving Institutions Program,
> and the Native Hawaiian-Serving Institutions Program.
> [See]{.underline} Sections 311, 316, and 317 of the HEA, respectively.
>
> **(a) Quality of the Applicant's Comprehensive Development Plan**
>
> **(1)** The strengths, weaknesses, and significant problems of the
> institution's academic programs, institutional management, and fiscal
> stability are clearly and comprehensively analyzed and result from a
> process that involved major constituencies of the institution.
>
> ***Content:*** Separately describe and analyze your institution\'s
> strengths, weaknesses, and significant problems in the following three
> areas as they relate to [each]{.underline} proposed activity:
>
> 1\. Academic programs,
>
> 2\. Institutional management, and
>
> 3\. Fiscal stability.
>
> We are considering "weaknesses" and "significant problems" to be one
> and the same. Use the grant funds to address some of these weaknesses
> and problems. Here are some guidelines for stating the problems:

-   State what is "too high" or what is "too low". For example, the
    percentage of freshmen students who fail four courses is too high.
    When you state the problem this way, the objectives become obvious.
    Such as, "to decrease, from 42% to 30%, the percentage of freshmen
    students who fail four courses."

-   Avoid problem statements that declare the problem as \"the lack of
    \" or \"the need for\" the very solution you are proposing for
    funding. Such as, \"the problem with our academic programs is a lack
    of or need for student services outside the classroom. Thus, we
    propose an activity to establish those student services.\" This type
    of statement usually contains circular reasoning.

-   Provide summaries of or excerpts from recent data, reports,
    evaluations or studies that demonstrate that you have objectively
    and thoroughly analyzed your institution's main problems.

-   Describe the process you used to formulate the above information.

-   Provide evidence of the extent and nature of the faculty, staff,
    students, community, industry, and other major constituents\'
    involvement in this process. You may rely on previously written
    information, such as a self-study for accreditation, as long as your
    process for developing the information involved the major
    constituencies\' representatives and reflects your institution\'s
    current situation.

> **(2)** The goals for the institution's academic programs,
> institutional management, and fiscal stability are realistic and based
> on comprehensive analysis.
>
> ***Content:*** Based on a comprehensive analysis of your
> institution\'s strengths, weaknesses, and significant problems,
> separately state the institutional goals as they relate to
> [each]{.underline} proposed activity, you plan to address using Title
> III, Part A funds.
>
> **(3)** The objectives stated in the plan are measurable, related to
> institutional goals, and if achieved, will contribute to the growth
> and self-sufficiency of the institution.
>
> ***Content:*** Focusing only on the institutional objectives that are
> specifically related to your proposed Title III, Part A activities,
> separately provide measurable objectives for how you will reach each
> of the goals as you discussed in #2. Achieving the objectives outlined
> should contribute to the growth and self-sufficiency of the
> institution.
>
> **EXAMPLE:**
>
> [Specific Tasks]{.underline}
>
> Institutionalize personnel, programs and services.
>
> [Methods Involved]{.underline}
>
> Operational funding budgeted and allocated to sustain improvements.
>
> [Tangible Results]{.underline}
>
> Program, services and personnel fully institutionalized.
>
> **(4)** The plan clearly and comprehensively describes the methods and
> resources the institution will use to institutionalize practices and
> improvements developed under the proposed project, including, in
> particular, how operational costs for personnel, maintenance, and
> upgrades of equipment will be paid with institutional resources.
>
> ***Content:*** In this section, separately describe the following for
> each proposed activity:
>
> The methods your institution will use to integrate practices and
> improvements developed into its operations and, if appropriate,
> continue them after the grant ends. For example, provide specifics on
> how your institution will obtain approval from appropriate internal
> and/or external governance authorities to conduct new or revised
> curricula and use new intervention strategies. What will the time
> period be for these actions?

1.  The resources you will need to institutionalize newly developed
    practices and improvements and, most importantly, how you will fund
    them. In particular, discuss how your institution will fund
    operational costs such as personnel, maintenance, and upgraded
    equipment. For example, one way to ensure that positions continue
    after the grant ends is for your institution to pay a percentage of
    the salary during the grant and increase that percentage during
    years two, three, four, and five.

2.  If you are applying under the TCCU or ANNH Program, incorporate your
    institution's five-year plan for improving the assistance it
    provides to the target student population (American Indian, Alaska
    Native or Native Hawaiian) within your CDP. If you are an applicant
    under the TCCU Program, you will also need to address your
    institution's plan to increase rates at which American Indian
    secondary school students enroll in higher education, and to
    increase overall post-secondary retention rates for American Indian
    students.

> **(b) Quality of Activity Objectives**
>
> \(1\) The extent to which the objectives for each activity are
> realistic and defined in terms of measurable results.
>
> ***Content:*** State your annual objectives, separately for
> [each]{.underline} activity, which, when combined with their
> performance indicator(s), are measurable and realistic (not too high,
> not too low). Connect each objective to the problem or weakness it
> should address, as you described in the CDP. In addition:

-   DO NOT identify process objectives such as: \"To establish a
    college-wide committee", whose measurement is: \"We formed a
    committee.\" Identify processes or tasks under the Implementation
    Strategy, as discussed next.

-   DO use words such as \"to increase\" or \"to decrease\" since you
    are more likely to be describing a genuine, outcome objective.

-   DO NOT begin your objective with words such as \"to provide,\" \"to
    develop,\" or \"to establish.\" This heightens the likelihood you
    may be describing a process or task rather than an outcome
    objective.

-   DO provide a realistic number of objectives and performance
    indicators for [each]{.underline} proposed activity and for each
    year you are requesting funds for that activity.

> \(2\) The extent to which the objectives for each activity are
> directly related to the problems to be solved and to the goals of the
> comprehensive development plan.
>
> ***Content*:** Separately describe how meeting the objectives of
> [each]{.underline} proposed activity will address a problem identified
> in the CDP and affect your institution\'s ability to address its goals
> for its academic programs, institutional management, or fiscal
> stability.
>
> If you need funds for more than one activity, you may propose
> different start and end dates and vary the duration of each. For
> example, you may need only three years to develop a new curriculum but
> five years to develop a new management information system. Any
> proposed activity should address a critical problem that the CDP
> describes as hindering institutional growth and self-sufficiency. If
> you propose to use up to 20% for endowment investing, do not write an
> activity narrative regarding this use of endowment investing, as we do
> not consider it an activity in the usual sense.
>
> **(c) Quality of Implementation Strategy**
>
> **(1)** The extent to which the implementation strategy for each
> activity is comprehensive.
>
> **(2)** The extent to which the rationale for the implementation
> strategy for each activity is clearly described and is supported by
> the results of relevant studies or projects.
>
> ***Content:*** For each proposed activity, explain why you chose a
> specific method for implementing that activity. Include how you
> determined that method to be most effective, indicating relevant
> studies or projects that you reviewed and experts that you consulted.
>
> **(3)** The timetable for each activity is realistic and likely to be
> attained.

-   Chart an implementation strategy to meet your objectives for each
    year you are requesting funds and for each activity.

-   Use time frames that are realistic for completing a task. Chart each
    of the five years using the budget period of October 1 to September
    30.

-   Describe in a comprehensive, sequential and clear manner who will do
    what and how they will do it to meet the objectives of each
    activity.

-   Identify, by title, the primary participants who will carry out the
    tasks to meet the objectives. Describe how the personnel will
    perform the tasks and the results you expect from them.

> **(d) Quality of Key** **Personnel**
>
> **(1)** The extent to which the experience and training of key
> professional personnel are directly related to the stated activity
> objectives.
>
> **(2)** The extent to which the time commitment of key personnel is
> realistic.
>
> ***Content:*** For each proposed activity, list, by title and name (if
> available) which positions are being proposed using Title III funds
> and describe the qualifications you require of that position and the
> amount of time each person will allot to the proposed activity.
>
> If you want to use a consultant, explain why a consultant is more
> advantageous than using the institution's personnel.
>
> **(e) Quality of Project Management Plan**
>
> **(1)** The extent to which procedures for managing the project are
> likely to ensure efficient and effective project implementation.
>
> **(2)** The extent to which project coordinator and activity directors
> have sufficient authority to conduct the project effectively,
> including access to the president or chief executive officer.
>
> The following information applies to the Title III, Part A,
> coordinator position:

-   Under "Quality of Key Personnel", be sure to include the
    coordinator\'s required qualifications (education, experience,
    training) and the specific duties of the position. Directly relate
    the duties to the stated purposes and objectives of the project.

```{=html}
<!-- -->
```
-   Indicate how much time the Title III, Part A, coordinator will
    commit to the project. Make the time commitment realistic, not too
    high nor too low, relative to the tasks the individual will perform.

> Note: Your Title III, Part A coordinator's time commitment to a
> project may vary considerably from that in another project or another
> institution's project. One project focused on developing a management
> information system, for example, may have a coordinator who is the
> director of technology in the ordinary hierarchy of the college. He or
> she may allot 10 percent time to coordinate the project for which the
> college will pay. On the other hand, a new coordinator of a faculty
> development project may be an instructional developer with a 50
> percent time or maybe 100 percent time commitment paid for with Title
> III, Part A, funds. Carefully think through the management structure
> and time commitment that will work best at your institution and
> specify the reasons for your choice.

-   Describe the procedures the project coordinator (project director)
    will use to manage and monitor the project\'s progress such as how
    information will be provided to key administrators so they can
    integrate project activities with related, on-going institutional
    activities.

-   Describe the project coordinator\'s (project director)
    administrative authority over the activity director(s) who is
    normally responsible for accomplishing a specific activity\'s
    objectives. Also, describe the administrative authority of the
    activity director(s) over subordinates.

-   Chart the lines of authority of the project coordinator to key
    institutional decision makers, including the president.

> **(f) Quality of Evaluation Plan**
>
> **(1)** The extent to which the data elements and the data collection
> procedures are clearly described and appropriate to measure the
> attainment of activity objectives and to measure the success of the
> project in achieving the goals of the comprehensive development plan.
>
> ***Content:*** For each proposed activity, describe the data
> collection procedures the institution will use to identify the data
> elements, objectives, and goals identified in the CDP. Include measure
> attainment of each proposed activity. Include procedures for analyzing
> and using both formative (outputs) and summative (outcomes) data.
>
> **(2)** The extent to which the data analysis procedures are clearly
> described and are likely to produce formative and summative results on
> attaining activity objectives and measuring the success of the project
> on achieving the goals of the comprehensive development plan.
>
> ***Content:*** For each proposed activity, describe in detail the
> project\'s evaluation plan, including who, what, when and how. Define
> the baseline indicators of progress that you will use.
>
> The detailed evaluation plan should:

-   Produce a valid assessment of your implementation strategies;

-   Result in annual, quantifiable evidence of the extent to which you
    attained your objectives for each activity and your goals for which
    funding is requested;

-   Include the data elements and collection procedures that you will
    use; and

-   Describe procedures for analyzing and using both formative and
    summative data.

> All applicants must submit a plan to conduct a project evaluation as
> part of their grant activities. The planned evaluation should be
> systematic in assessing the worth of a project and useful in guiding
> project objectives and focus primarily on determining the outcomes and
> impacts of the project relative to those objectives. The evaluation
> should also serve to strengthen the management of the project and lead
> to better knowledge of what works in producing the desired outcomes.
>
> An individual or organization, independent of the project team (and
> all of its partners), but not necessarily external to the grantee
> institution, should execute the project evaluation plan. This
> independent evaluator should assist in the initial preparation of the
> evaluation plan and be willing to work alongside the project team
> throughout the duration of the project. The evaluator should possess
> good evaluation skills commonly found among practitioners of the
> American Evaluation Association. Helpful websites to consult when
> preparing an evaluation plan include:

-   Department of Education's Fund for the Improvement of Postsecondary
    Education: [www.ed.gov/FIPSE](http://www.ed.gov/FIPSE)

-   National Science Foundation: [www.nsf.gov](http://WWW.NSF.GOV/)

-   Kellogg Foundation: <http://www.wkkf.org/> (for their evaluation
    handbook)

> The project director and team should be committed to gathering the
> best evaluation data possible for formative and summative purposes.
> Projects should collect baseline data before the project starts as a
> basis for measuring progress.
>
> A summary of the evaluation report must be included in the final
> performance report submitted by the project to the Department of
> Education. The report, which also includes fiscal and management
> performance information, is due within 90 days after expiration of the
> award. The evaluation report should be included as an appendix to the
> final performance report as well as available upon request. (Please
> see 34 CFR 75.217 for information on how project performance may
> affect future funding).
>
> For the Title III, Part A Programs, the evaluation plan should produce
> a valid assessment of the implementation strategies. It should also
> result in annual, quantifiable evidence of the attainment of
> objectives for each activity and of the goals in the CDP.
>
> **(g) Budget (This selection criteria must be included in the program
> narrative document attached to the "Project Narrative Attachment.")**
>
> The extent to which the proposed costs are necessary and reasonable in
> relation to the project's objectives and scope.
>
> ***Content:*** Review the program regulations, (34 CFR 607.10 and
> 607.30), for guidance on which activities and costs are allowable. For
> example, you may [not]{.underline} use your grant funds to:
>
> \- Recruit students,
>
> \- Carry out activities that are operational rather than
> developmental,
>
> \- Carry out student activities such as entertainment, cultural or
> social enrichment programs, student publications, social clubs or
> associations,
>
> \- Pay for organized fund raising,
>
> \- Cover indirect costs.
>
> Prepare a separate, detailed, budget narrative for each proposed
> activity for each year you are requesting grant funds. Demonstrate and
> justify that all costs are reasonable in today's market and necessary
> to accomplish your activity objectives. Please pay particular
> attention in your justification to those (per item) costs exceeding
> \$25,000, excluding salaries and fringe benefits. For each activity,
> provide itemized costs (in dollars), and a narrative justification to
> support your request for:

-   Personnel

-   Fringe Benefits

-   Travel

-   Equipment

-   Supplies

-   Contractual

-   Construction

-   Other

-   Total

> You must provide details so we can determine if the costs are
> allowable, necessary and reasonable.
>
> **NOTE: The Title III, Part A, Strengthening Institutions Programs,
> CFDA 84.031A, T, N, and W) do not reimburse grantees for indirect
> costs they incur in carrying out a project funded under these
> programs. Therefore, applicants should not show any dollar amounts for
> indirect costs on either line 10 of the application budget form (ED
> 524) or in their budget narrative. Applicants should also be aware
> that un-reimbursed indirect costs under grants of this program may not
> be charged as direct cost items in the same award, used to satisfy
> matching or cost-sharing requirements, or charged to another Federal
> award.**

Do not include a budget narrative (as a separate activity) for endowment
investing.

> **Note**: Check all combined totals for the proposed activity budgets
> and compare it to the total on the ED 524. The totals must match.
>
> **6 U. S. Department of Education Budget Information Non-Construction
> Programs (Section A - Budget Summary U.S. Department of Education
> Funds and Section B -- Budget Summary Non-Federal Funds (ED 524
> form)).**
>
> First, carefully read the instructions contained in this document.
> Then, using the Dept of Education Budget Information for
> Non-Construction Programs (ED524) form, prepare a budget for the
> [entire]{.underline} project that totals all the costs for each year
> of the grant. If you choose to use up to 20 percent of grant funds to
> establish or increase your institution's endowment fund through
> endowment investing, enter the amount of your contribution in the
> summary budget on the "other" line. If you have additional items for
> the other category, separate the endowment contribution from the other
> items and make two entries for "other." Endowment monies should be
> listed first.
>
> **7. Required Assurances and Certifications**
>
> All applicants must submit these forms electronically, as a part of
> your application.

-   Assurances -- Non-Construction Programs (SF 424-B)

-   Grants.gov Lobbying Form (used in place of ED 80-0013)

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

-   Disclosure of Lobbying Activities (SF -- LLL)

-   ED GEPA 427 Form - General Education Provisions Act Section 427
    Requirements. Please refer to the GEPA 427 requirements outlined in
    the "Notice to All Applicants" for instructions on completing this
    statement

```{=html}
<!-- -->
```
-   Survey on Ensuring Equal Opportunity for Applicants (OMB No.
    1890-0014) \[voluntary submission\]

> Carefully read the instructions for each form and be sure to provide
> all the requested information.

**TCCU CONSTRUCTION AND ANNH RENOVATION GRANT APPLICATIONS**

This section provides you with information critical to your successful
completion and submission of a one-year **TCCU Construction or ANNH
Renovation Grant** application.

When developing your application, be sure to address the selection
criteria (34 CFR §607.22) as precisely as possible to ensure your
application contains the information readers will need to judge the
quality of the proposed construction or renovation project.

NOTE: Your construction or renovation grant application must address
items numbered 1 through 7 on pages 14 -- 23, as required of the
development grant applicants and in the same order.

[\[insert revised CDN here\]]{.mark}

> []{.mark}

**Executive Order 12372 \-- Intergovernmental Review**

**APPENDIX**

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

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

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

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

Any State Process Recommendation and other comments submitted by a State
Single Point of Contact and any comments from State, areawide, regional,
and local entities must be mailed or hand-delivered by the date
indicated in the actual application notice to the following address: The
Secretary, EO 12372\--CFDA# \[commenter must insert number\--including
suffix letter, if any\], U.S. Department of Education, room
[7W301]{.underline}, 400 Maryland Avenue, SW., Washington, DC 20202.

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

PLEASE NOTE THAT THE ABOVE ADDRESS IS NOT THE SAME ADDRESS AS THE ONE TO
WHICH THE APPLICANT SUBMITS ITS COMPLETED APPLICATION. [DO NOT SEND
APPLICATIONS TO THE ABOVE ADDRESS]{.underline}.

**STATE SINGLE POINTS OF CONTACT (SPOCs)**

> It is estimated that in 2004 the Federal government will outlay \$400
> billion in grants to state and local governments. Executive Order
> 12372, \"Intergovernmental Review of Federal Programs,\" was issued
> with the desire to foster the intergovernmental partnership and
> strengthen federalism by relying on state and local processes for the
> coordination and review of proposed federal financial assistance and
> direct federal development. The Order allows each state to designate
> an entity to perform this function. Below is the official list of
> those entities. For those states that have a home page for their
> designated entity, a direct link has been provided on the official
> version: [http://www.whitehouse.gov/omb/grants/spoc.html]{.underline}
>
> **States that are not listed on this page have chosen not to
> participate in the intergovernmental review process, and therefore do
> not have a SPOC. If you are located within one of these states, you
> may still send application materials directly to a federal awarding
> agency.**
>
> Contact information for federal agencies that award grants can be
> found in [The Catalog of Federal Domestic Assistance Catalog Contents
> Page](http://12.46.245.173/pls/portal30/CATALOG.BROWSE_CATALOG_DYN.show).
> You can access Appendix IV by Agency
> \[http://12.46.245.173/CFDA/appx4_web.pdf\] or by State
> \[http://12.46.245.173/CFDA/appx4_web_state.pdf\].

+--------------------------------------+-------------------------------+
| [**ARKANSAS**](http://w              | [**CALIFOR                    |
| ww.whitehouse.gov/goodbye/45b34a17bc | NIA**](http://www.whitehouse. |
| c01d55a678350a2eedaddd1856d98d.html) | gov/goodbye/cf1a58b969f7b0647 |
|                                      | 0a7931ed7e9581c5e8fab5c.html) |
| Tracy L. Copeland                    |                               |
|                                      | Grants Coordination           |
| Manager, State Clearinghouse         |                               |
|                                      | State Clearinghouse           |
| Office of Intergovernmental Services |                               |
|                                      | Office of Planning and        |
| Department of Finance and Admin.     | Research                      |
|                                      |                               |
| 1515 W. 7th St., Room 412            | P.O. Box 3044, Room 222       |
|                                      |                               |
| Little Rock, Arkansas 72203          | Sacramento, California        |
|                                      | 95812-3044                    |
| Telephone: (501) 682-1074            |                               |
|                                      | Telephone: (916) 445-0613     |
| Fax: (501) 682-5206                  |                               |
|                                      | Fax: (916) 323-3018           |
| [tlcopeland@dfa.state.ar.us]         |                               |
| (mailto:tlcopeland@dfa.state.ar.us ) | <st                           |
|                                      | ate.clearinghouse@opr.ca.gov> |
+--------------------------------------+-------------------------------+
| [**DELAWARE**](http://w              | [**DISTRICT OF                |
| ww.whitehouse.gov/goodbye/6933b8af48 | COLUM                         |
| e27a67ce4a28e97c0c66e0dc7d9e4d.html) | BIA**](http://www.whitehouse. |
|                                      | gov/goodbye/cd10d790887e7f4a2 |
| Sandra R. Stump                      | 796ea8d1b5efeb46b979ca1.html) |
|                                      |                               |
| Executive Department                 | Marlene Jefferson             |
|                                      |                               |
| Office of the Budget                 | DC Government Office of       |
|                                      | Partnerships                  |
| 540 S. Dupont Highway, 3rd Floor     |                               |
|                                      | And Grants Development        |
| Dover, Delaware 19901                |                               |
|                                      | 441 4th Street, N.W.          |
| Telephone: (302) 739-3323            |                               |
|                                      | Washington, DC 20001          |
| Fax: (302) 739-5661                  |                               |
|                                      | Telephone: (202) 727-6518     |
| [sandy.stump@state.de.               |                               |
| us](mailto:sandy.stump@state.de.us ) | Fax: (202) 727-1652           |
|                                      |                               |
|                                      | [marlene.                     |
|                                      | Jefferson@dc.gov]{.underline} |
+--------------------------------------+-------------------------------+
| [**FLORIDA**](http://w               | [**GEOR                       |
| ww.whitehouse.gov/goodbye/63b38d2041 | GIA**](http://www.whitehouse. |
| cfd8b0b37935b1583b944fd8efc98f.html) | gov/goodbye/898508bd9ea5e4291 |
|                                      | 92b9f78d3792fca2fc79701.html) |
| Lauren P. Milligan                   |                               |
|                                      | Barbara Jackson               |
| Florida State Clearinghouse          |                               |
|                                      | Georgia State Clearinghouse   |
| Florida Dept. of Environmental       |                               |
| Protection                           | 270 Washington Street, SW,    |
|                                      | 8^th^ Floor                   |
| 3900 Commonwealth Blvd., Mail        |                               |
| Station 47                           | Atlanta, Georgia 30334        |
|                                      |                               |
| Tallahassee, Florida 32399-3000      | Telephone: (404) 656-3855     |
|                                      |                               |
| Telephone: (850) 245-2161            | Fax: (404) 656-7901           |
|                                      |                               |
| Fax: (850) 245-2190                  | <gach@mail.opb.state.ga.us>   |
|                                      |                               |
| <Lauren.Milligan@dep.state.fl.us>    |                               |
+--------------------------------------+-------------------------------+

+------------------------------------+---------------------------------+
| [**ILLINOIS**](http://www.wh       | **IOWA**\                       |
| itehouse.gov/goodbye/4ca59f3262146 | Kathy Mable\                    |
| f0bf55304cd9d98d8b5485a0dd8.html)\ | Iowa Department of Management   |
| Roukaya McCaffrey\                 |                                 |
| Department of Commerce and\        | State Capitol Building Room G   |
|    Economic Opportunities\         | 12\                             |
| 620 East Adams, 6th Floor\         | 1007 E Grand Avenue\            |
| Springfield, Illinois 62701\       | Des Moines, Iowa 50319\         |
| Telephone: (217) 524-0188\         | Telephone: (515) 242-8834\      |
| Fax: (217) 558-0473\               | Fax: (515) 242-5897\            |
| [roukaya_m                         | <Kathy.Mable@iowa.gov>          |
| ccaffrey@illinoisbiz.biz](mailto:r |                                 |
| oukaya_mccaffrey@illinoisbiz.biz ) |                                 |
+------------------------------------+---------------------------------+
| **KENTUCKY**\                      | **MAINE**\                      |
| Ron Cook\                          | Joyce Benson\                   |
| The Govenor's Office for Local     | State Planning Office\          |
| Development\                       | 184 State Street\               |
| 1024 Capital Center Drive, Suite   | 38 State House Station\         |
| 340\                               | Augusta, Maine 04333\           |
| Frankfort, Kentucky 40601\         | Telephone: (207) 287-3261\      |
| Telephone: (502) 573-2382/(800)    | (direct): (207) 287-1461\       |
| 346-5606\                          | Fax: (207) 287-6489\            |
| Fax: (502) 573-2512\               | <joyce.benson@state.me.us>      |
| [R]{.underl                        |                                 |
| ine}<on.cook@Ky.>[Gov]{.underline} |                                 |
+------------------------------------+---------------------------------+
| [**MARYLAND**](http://www.wh       | **MICHIGAN**\                   |
| itehouse.gov/goodbye/53cef4f1cabee | Richard Pfaff\                  |
| af32421c742009c1247dcd9e156.html)\ | Southeast Michigan Council of   |
| Linda C. Janey, J.D.\              | Governments\                    |
| Director, Capital Planning and     | 535 Griswold, Suite 300\        |
|                                    | Detroit, Michigan 48226\        |
| Development Review\                | Telephone: (313) 961-4266\      |
| Maryland Department of Planning\   | Fax: (313) 961-4869\            |
| 301 West Preston Street, Room      | <pfaff@semcog.org>              |
| 1104\                              |                                 |
| Baltimore, Maryland 21201-2305\    |                                 |
| Telephone: (410) 767-4490\         |                                 |
| Fax: (410) 767-4480\               |                                 |
| <linda@mail.op.state.md.us>        |                                 |
+------------------------------------+---------------------------------+
| **MISSISSIPPI**\                   | [**                             |
| Mildred Tharpe\                    | MISSOURI**](http://www.whitehou |
| Clearinghouse Officer\             | se.gov/goodbye/d151d8f3a7c159b0 |
| Department of Finance and          | 3c222c07d79e8d0b1fdccdc4.html)\ |
| Administration\                    | Federal Assistance              |
| 1301 Woolfolk Building, Suite E\   | Clearinghouse\                  |
| 501 North West Street\             | Office of Administration\       |
| Jackson, Mississippi 39201\        | P.O. Box 809\                   |
| Telephone: (601) 359-6762\         | Truman Building, Room 840\      |
| Fax: (601) 359-6758                | Jefferson City, Missouri 65102\ |
|                                    | Telephone: (573) 751-4834\      |
|                                    | Fax: (573) 522-4395\            |
|                                    | <igr@mail.oa.state.mo.us>       |
+------------------------------------+---------------------------------+
| [**NEVADA**](http://www.wh         | [**NEW                          |
| itehouse.gov/goodbye/be5d3d8b9b3d1 | H                               |
| 28ba076ed34765f8c725f24e1c0.html)\ | AMPSHIRE**](http://www.whitehou |
| Michael Stafford\                  | se.gov/goodbye/95d4995c7e389202 |
| Department of Administration\      | 87f0ac19b85a5e4a6511a151.html)\ |
| State Clearinghouse\               | MaryAnn Manoogian\              |
| 209 E. Musser Street, Room 200\    | Director, New Hampshire Office  |
| Carson City, Nevada 89701\         | of                              |
| Telephone: (775) 684-0209\         |                                 |
| Fax: (775) 684-0260\               | Energy and Planning\            |
| [mstafford@budget.state.nv.us](ma  | Attn: Intergovernmental Review  |
| ilto:helliott@govmail.state.nv.us) | Process\                        |
|                                    | Benjamin Frost\                 |
|                                    | 57 Regional Drive\              |
|                                    | Concord, New Hampshire          |
|                                    | 03301-8519\                     |
|                                    | Telephone: (603) 271-2155\      |
|                                    | Fax: (603) 271-2615\            |
|                                    | <irp@nh.gov>                    |
+------------------------------------+---------------------------------+
| **NEW YORK**\                      | [**NORTH                        |
| Linda Shkreli\                     | DAKOTA**](http://www.whitehou   |
| Office of Public Security\         | se.gov/goodbye/f549674d3662fbaf |
| Homeland Security Grants           | 55ea74f5a14640c0d79867c0.html)\ |
| Coordination\                      | Jim Boyd\                       |
| 633 3rd Avenue\                    | ND Department of Commerce\      |
| New York, New York 10017\          | 1600 East Century Avenue, Suite |
| Telephone: (212) 867-1289\         | 2\                              |
| Fax: (212) 867-1725                | P.O. Box 2057\                  |
|                                    | Bismarck, North Dakota          |
|                                    | 58505-2057\                     |
|                                    | Telephone: (701) 328-2676\      |
|                                    | Fax: (701) 328-2308\            |
|                                    | <jboyd@state.nd.us>             |
+------------------------------------+---------------------------------+

  ----------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------
  **RHODE ISLAND**\                                                                               [**SOUTH
  Joyce Karger\                                                                                   CAROLINA**](http://www.whitehouse.gov/goodbye/b0ee3f975f4f84ce8709d07322dafd8d901fdcfc.html)\
  Department of Administration\                                                                   SC Clearinghouse\
  Statewide Planning Program\                                                                     Budget and Control Board\
  One Capitol Hill\                                                                               Office of State Budget\
  Providence, Rhode Island 02908-5870\                                                            1201 Main Street, Suite 950\
  Telephone: (401) 222-6181\                                                                      Columbia, South Carolina 29201\
  Fax: (401) 222-2083\                                                                            Telephone: (803) 734-0494\
  [jkarger@doa.state.ri.us](mailto:knelson@doa.state.ri.us)                                       Fax: (803) 734-0645\
                                                                                                  <clearinghouse@budget.state.sc.us>

  [**TEXAS**](http://www.whitehouse.gov/goodbye/aa749e01ac59650d5f83ef05c0fb91e650483c90.html)\   [**UTAH**](http://www.whitehouse.gov/goodbye/955fd5813088bc15036d64297f09fbe699bf1ca2.html)\
  Denise S. Francis\                                                                              Sophia DiCaro\
  Director, State Grants Team\                                                                    Utah State Clearinghouse\
  Governor\'s Office of Budget and Planning\                                                      Governor\'s Office of Planning and Budget Utah\
  P.O. Box 12428\                                                                                 Capitol Complex\
  Austin, Texas 78711\                                                                            Suite E210, P.O. Box 142210\
  Telephone: (512) 305-9415\                                                                      Salt Lake City, Utah 84114-2210\
  Fax: (512) 936-2681\                                                                            Telephone: (801) 538-1027\
  <dfrancis@governor.state.tx.us>                                                                 Fax: (801) 538-1547\
                                                                                                  [ddicaro@utah.gov](mailto:cwalters@utah.gov)

  **WEST VIRGINIA**\                                                                              [**WISCONSIN**](http://www.whitehouse.gov/goodbye/27884c4e1a60681000394e1dbb08817fbc688148.html)\
  Fred Cutlip, Director\                                                                          Jeff Smith\
  Community Development Division\                                                                 Section Chief, Federal/State Relations\
  West Virginia Development Office\                                                               Wisconsin Department of Administration\
  Building #6, Room 553\                                                                          101 East Wilson Street, 6th Floor\
  Charleston, West Virginia 25305\                                                                P.O. Box 7868\
  Telephone: (304) 558-4010\                                                                      Madison, Wisconsin 53707\
  Fax: (304) 558-3248\                                                                            Telephone: (608) 266-0267\
  <fcutlip@wvdo.org>                                                                              Fax: (608) 267-6931\
                                                                                                  <jeffrey.smith@doa.state.wi.us>

  **AMERICAN SAMOA**\                                                                             **GUAM**\
  Pat M. Galea\'i\                                                                                Director\
  Federal Grants/Programs Coordinator\                                                            Bureau of Budget and Mgmt. Research\
  Office of Federal Programs/Office of the Governor\                                              Office of the Governor\
  Department of Commerce\                                                                         P.O. Box 2950\
  American Samoa Government\                                                                      Agana, Guam 96910\
  Pago Pago, American Samoa 96799\                                                                Telephone: 011-671-472-2285\
  Telephone: (684) 633-5155\                                                                      Fax: 011-671-472-2825\
  Fax: (684) 633-4195\                                                                            <jer@ns.gov.gu>
  <pmgaleai@samoatelco.com>                                                                       

  **NORTH MARIANA ISLANDS**\                                                                      **PUERTO RICO**\
  Ms. Jacoba T. Seman\                                                                            Jose Caballero / Mayra Silva\
  Federal Programs Coordinator\                                                                   Puerto Rico Planning Board\
  Office of Management and Budget\                                                                Federal Proposals Review Office\
  Office of the Governor\                                                                         Minillas Government Center\
  Saipan, MP 96950\                                                                               P.O. Box 41119\
  Telephone: (670) 664-2289\                                                                      San Juan, Puerto Rico 00940-1119\
  Fax: (670) 664-2272\                                                                            Telephone: (787) 723-6190\
  <omb.jseman@saipan.com>                                                                         Fax: (787) 722-6783
  ----------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------

  ------------------------------------- ---------------------------------
  **VIRGIN ISLANDS**\                    
  Ira Mills\                            
  Director, Office of Management and    
  Budget\                               
  #41 Norre Gade Emancipation Garden    
  Station,\                             
  Second Floor\                         
  Saint Thomas, Virgin Islands 00802\   
  Telephone: (340) 774-0750\            
  Fax: (340) 776-0069\                  
  <lrmills@usvi.org>                    

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

**General Education Provisions Act (GEPA)**

**Section 427**

ALL APPLICANTS [MUST]{.underline} INCLUDE INFORMATION IN THEIR
APPLICATIONS TO ADDRESS THIS PROVISION IN ORDER TO RECEIVE FUNDING UNDER
THIS PROGRAM.

Section 427 requires each applicant to include in its application a
description of the steps the applicant proposes to take to ensure
equitable access to, and participation in, its federally-assisted
program for students, teachers, and other program beneficiaries with
special needs.

This section allows applicants discretion in developing the required
description. The statute highlights six barriers that can impede
equitable access or participation that you may address: *gender, race,
national origin, color disability,* or *age.*

A general statement of an applicant's nondiscriminatory hiring policy is
not sufficient to meet this requirement. Applicants must identify
potential barriers and explain steps they will take to overcome these
barriers.

\*Note: [Applicants are required to address this provision by attaching
a statement to the ED GEPA427 Form found in the application package
downloaded from Grants.gov**. **]{.underline}

**Government Performance and Results Act (GPRA)**

**What is GPRA?**

The Government Performance and Results Act of 1993 (GPRA) is a
straightforward statute that requires all federal agencies to manage
their activities with attention to the consequences of those activities.
Each agency is to clearly state what it intends to accomplish, identify
the resources required, and periodically report their progress to the
Congress. In so doing, it is expected that the GPRA will contribute to
improvements in accountability for the expenditures of public funds,
improve Congressional decision-making through more objective information
on the effectiveness of federal programs, and promote a new government
focus on results, service delivery, and customer satisfaction.

**How has the Department of Education Responded to the GPRA
Requirements?**

As required by GPRA, the Department of Education has prepared a
strategic plan for 2002-2007. This plan reflects the Department's
priorities and integrates them with its mission and program authorities
and describes how the Department will work to improve education for all
children and adults in the U.S. The Department's goals, as listed in the
plan, are:

**Goal 1: Create a Culture of Achievement.**

***Goal 2: Improve Student Achievement***

***Goal 3: Develop Safe Schools and Strong Character***

***Goal 4: Transform Education into an Evidence-based Field***

***Goal 5: Enhance the Quality of and Access to Postsecondary and Adult
Education***

***Goal 6: Establish Management Excellence***

The performance indicators for the Title III, Part A programs are part
of the Department's plan for meeting Goal 5: Ensure access to
postsecondary education and lifelong learning. One of the Department's
objectives for Goal 5 is to "reduce the gaps in college access and
completion among student populations differing by race/ethnicity,
socioeconomic status, and disability while increasing educational
attainment of all."

**What are the Performance Indicators for the Title III, Part A
Programs?**

The Title III, Part A programs' overarching goal is to provide grants to
eligible institutions of higher education to enable them to improve
their academic quality, institutional management, and fiscal stability,
and increase their self-sufficiency and strengthen their capacity to
make a substantial contribution to the higher education resources of the
Nation.

The Secretary has established the following key performance measures for
assessing the effectiveness of the Title III, Part A programs: 1) The
number of full-time degree-seeking undergraduates enrolling at IHEs.
Note that this is a long-term measure, which will be used periodically
to gauge performance, beginning in FY 2009; 2) The percentage of
full-time undergraduate students who were in their first year of
postsecondary enrollment in the previous year and are enrolled in the
current year at the same institution; 3) The percentage of students
enrolled at 4-year IHEs graduating within 6 years of enrollment; and 4)
The percentage of students enrolled at 2-year IHEs graduating within 3
years of enrollment.

**The success of the Title III, Part A program is measured by the
grantee's success in achieving these measures.** GPRA indicators are
not, however, intended to replace other project specific indicators.

**Instructions for Completing the** **Application Package**

The Title III, Part A program applications consist of four parts. These
parts are organized in the same manner that the submitted application
should be organized. The parts are as follows:

> **Part I:** Application for Federal Assistance (SF 424) and the
> Department of Education Supplemental Information for SF 424
>
> **Part II:** U. S. Department of Education Budget Information for
> Non-Construction Programs (ED 524)
>
> **Part III:** Required Narratives
>
> ["ED Abstract Form"]{.underline}
>
> "[Project Narrative Attachment Form]{.underline}"
>
> "[Other Attachments Form" (Program Profile Page)]{.underline}

**[NOTE]{.underline}**: In the Grants.gov application package,
applicants will find a list of "Mandatory Documents" which includes all
of the required forms, assurances, the "ED Abstract Form," the "Project
Narrative Attachment Form," and the "Other Attachments Form."

The **["ED Abstract Form"]{.underline}** (found in the Grants.gov
application package) is where the applicants will attach a
[one]{.underline} page abstract narrative to include an overview of your
proposed project and a description of your institution's distinguishing
features, including:

-   Your institution\'s level (2-year/4-year); control (private/public);
    affiliation; primary service population; and programs of study
    (e.g., liberal arts, technical programs).

-   Student Body Characteristics: include the number of students-either
    full-time equivalent or headcount - and the racial, ethnic, age, and
    gender breakdown.

-   Faculty Characteristics: include the number of full-time and adjunct
    faculty and faculty to student ratio.

The **"[Project Narrative Attachment Form]{.underline}"** (found in the
Grants.gov application package) is where applicants will attach their
narrative responses to the selection criteria that will be used to
evaluate applications submitted for this competition. The "budget
narrative" is part of the selection criteria and is to be included in
narrative attached to the "Project Narrative Attachment Form."
**Remember to submit a single narrative document that addresses each
proposed activity (except endowment investing). BE SURE TO ADHERE TO THE
ESTABLISHED PAGE LIMITATIONS OF:**

-   **50 pages for 5-year individual or cooperative arrangement
    development grants; and**

-   **35 pages for 1-year construction or renovation grants.**

The **"[Other Attachments Form]{.underline}"** (found in the Grants.gov
application package) is where applicants will attach the "Program
Profile" page. The "Program Profile" page is found in this instructions
document. Applicants must cut/copy and paste this page or recreate this
page into a separate .doc, .rtf, or .pdf document, complete the document
with the information requested, and attach it to the "Other Attachments
Form" found in the application package downloaded from Grants.gov.

**Part IV:** Assurances, Certifications, and Survey Forms

Applicants must complete the following forms included in the application
package:

Assurances for Non-Construction Programs (SF 424B)

Grants.gov Lobbying Form (formerly Certification Regarding Lobbying ED
80-0013)

Disclosure of Lobbying Activities (SF-LLL)

Certification Regarding Debarment, Suspension. Ineligibility and
Voluntary Exclusion---Lower Tier Covered Transactions (ED 80-0014)

ED GEPA 427 Form

::: Definition-Term
Survey on Ensuring Equal Opportunity for Applicants (voluntary
submission)
:::

## 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 preapplications 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:          |               | I | Entry:                     |
| t |                 |               | t |                            |
| e |                 |               | e |                            |
| m |                 |               | m |                            |
+---+-----------------+---------------+---+----------------------------+
| 1 | **Type of       |               | 1 | **Name Of Federal          |
| \ | Submission:**   |               | 0 | Agency**: (Required) Enter |
| . | (Required):     |               | \ | the name of the Federal    |
|   | Select one type |               | . | agency from which          |
|   | of submission   |               |   | assistance is being        |
|   | in accordance   |               |   | requested with this        |
|   | with agency     |               |   | application.               |
|   | instructions.   |               |   |                            |
|   |                 |               |   |                            |
|   | -               |               |   |                            |
|   |  Preapplication |               |   |                            |
|   |                 |               |   |                            |
|   | -   Application |               |   |                            |
|   |                 |               |   |                            |
|   | -   Ch          |               |   |                            |
|   | anged/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.       |               |   |                            |
+---+-----------------+---------------+---+----------------------------+
|   |                 |               | 1 | **Catalog Of Federal       |
|   |                 |               | 1 | 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         |               | 1 | **Funding Opportunity      |
| \ | Application:    |               | 2 | Number/Title:** (Required) |
| . | (Required)      |               | \ | Enter the Funding          |
|   | Select one type |               | . | Opportunity Number and     |
|   | of application  |               |   | title of the opportunity   |
|   | in accordance   |               |   | under which assistance is  |
|   | with agency     |               |   | requested, as found in the |
|   | instructions.   |               |   | program announcement.      |
|   |                 |               |   |                            |
|   | -   New -- An   |               |   |                            |
|   |     application |               |   |                            |
|   |     that is     |               |   |                            |
|   |     being       |               |   |                            |
|   |     submitted   |               |   |                            |
|   |     to an       |               |   |                            |
|   |     agency for  |               |   |                            |
|   |     the first   |               |   |                            |
|   |     time.       |               |   |                            |
|   |                 |               |   |                            |
|   | -               |               |   |                            |
|   |  Continuation - |               |   |                            |
|   |     An          |               |   |                            |
|   |     extension   |               |   |                            |
|   |     for an      |               |   |                            |
|   |     additional  |               |   |                            |
|   |                 |               |   |                            |
|   |  funding/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)       |               |   |                            |
+---+-----------------+---------------+---+----------------------------+
|   |                 |               | 1 | **Competition              |
|   |                 |               | 3 | Identification             |
|   |                 |               | \ | Number/Title:** Enter the  |
|   |                 |               | . | Competition Identification |
|   |                 |               |   | Number and title of the    |
|   |                 |               |   | competition under which    |
|   |                 |               |   | assistance is requested,   |
|   |                 |               |   | if applicable.             |
+---+-----------------+---------------+---+----------------------------+
|   |                 |               | 1 | **Areas Affected By        |
|   |                 |               | 4 | 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          |               | 1 | **Descriptive Title of     |
| \ | Received:**     |               | 5 | Applicant's Project:**     |
| . | Leave this      |               | \ | (Required) Enter a brief   |
|   | field blank.    |               | . | descriptive title of the   |
|   | This date will  |               |   | project. If appropriate,   |
|   | be assigned by  |               |   | attach a map showing       |
|   | the Federal     |               |   | project location (e.g.,    |
|   | agency.         |               |   | construction or real       |
|   |                 |               |   | property projects). For    |
|   |                 |               |   | preapplications, attach a  |
|   |                 |               |   | summary description of the |
|   |                 |               |   | project.                   |
+---+-----------------+---------------+---+----------------------------+
| 4 | **Applicant     |               |   |                            |
| \ | Identifier**:   |               |   |                            |
| . | Enter the       |               |   |                            |
|   | entity          |               |   |                            |
|   | identifier      |               |   |                            |
|   | assigned by the |               |   |                            |
|   | Federal agency, |               |   |                            |
|   | if any, or      |               |   |                            |
|   | applicant's     |               |   |                            |
|   | control number, |               |   |                            |
|   | if applicable.  |               |   |                            |
+---+-----------------+---------------+---+----------------------------+
| 5 | **Federal       |               | 1 | **Congressional Districts  |
| a | Entity          |               | 6 | Of**: (Required) 16a.      |
|   | Identifier**:   |               | \ | Enter the applicant's      |
|   | Enter the       |               | . | Congressional District,    |
|   | number assigned |               |   | and 16b. Enter all         |
|   | to your         |               |   | District(s) affected by    |
|   | organization by |               |   | the program or project.    |
|   | the Federal     |               |   | Enter in the format: 2     |
|   | Agency, if any. |               |   | characters State           |
|   |                 |               |   | Abbreviation -- 3          |
|   |                 |               |   | characters District        |
|   |                 |               |   | Number, e.g., CA-005 for   |
|   |                 |               |   | California 5th^th^         |
|   |                 |               |   | district, CA-012 for       |
|   |                 |               |   | 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 Award |               |   |                            |
| b | Identifier**:   |               |   |                            |
| . | For new         |               |   |                            |
|   | applications    |               |   |                            |
|   | leave blank.    |               |   |                            |
|   | For a           |               |   |                            |
|   | continuation or |               |   |                            |
|   | revision to an  |               |   |                            |
|   | existing award, |               |   |                            |
|   | enter the       |               |   |                            |
|   | previously      |               |   |                            |
|   | assigned        |               |   |                            |
|   | Federal award   |               |   |                            |
|   | identifier      |               |   |                            |
|   | number. If a    |               |   |                            |
|   | ch              |               |   |                            |
|   | anged/corrected |               |   |                            |
|   | application,    |               |   |                            |
|   | enter the       |               |   |                            |
|   | Federal         |               |   |                            |
|   | Identifier in   |               |   |                            |
|   | accordance with |               |   |                            |
|   | agency          |               |   |                            |
|   | instructions.   |               |   |                            |
+---+-----------------+---------------+---+----------------------------+
| 6 | **Date Received |               |   |                            |
| \ | by State:**     |               |   |                            |
| . | Leave this      |               |   |                            |
|   | field blank.    |               |   |                            |
|   | This date will  |               |   |                            |
|   | be assigned by  |               |   |                            |
|   | the State, if   |               |   |                            |
|   | applicable.     |               |   |                            |
+---+-----------------+---------------+---+----------------------------+
| 7 | **State         |               |   |                            |
| \ | Application     |               |   |                            |
| . | Identifier:**   |               |   |                            |
|   | Leave this      |               |   |                            |
|   | field blank.    |               |   |                            |
|   | This identifier |               |   |                            |
|   | will be         |               |   |                            |
|   | assigned by the |               |   |                            |
|   | State, if       |               |   |                            |
|   | applicable.     |               |   |                            |
+---+-----------------+---------------+---+----------------------------+
| 8 | **Applicant     |               |   |                            |
| \ | Information**:  |               |   |                            |
| . | Enter the       |               |   |                            |
|   | following in    |               |   |                            |
|   | accordance with |               |   |                            |
|   | agency          |               |   |                            |
|   | instructions:   |               |   |                            |
|   |                 |               |   |                            |
|   | **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.        |               |   |                            |
+---+-----------------+---------------+---+----------------------------+
|   |                 |               |   |                            |
+---+-----------------+---------------+---+----------------------------+
|   |                 |               | 1 | **Proposed Project Start   |
|   |                 |               | 7 | and End Dates**:           |
|   |                 |               | \ | (Required) Enter the       |
|   |                 |               | . | proposed start date and    |
|   |                 |               |   | end date of the project.   |
+---+-----------------+---------------+---+----------------------------+
|   | **b.            |               |   |                            |
|   | Em              |               |   |                            |
|   | ployer/Taxpayer |               |   |                            |
|   | Number          |               |   |                            |
|   | (EIN/TIN):**    |               |   |                            |
|   | (Required):     |               |   |                            |
|   | Enter the       |               |   |                            |
|   | Employer or     |               |   |                            |
|   | Taxpayer        |               |   |                            |
|   | Identification  |               |   |                            |
|   | Number (EIN or  |               |   |                            |
|   | TIN) as         |               |   |                            |
|   | assigned by the |               |   |                            |
|   | Internal        |               |   |                            |
|   | Revenue         |               |   |                            |
|   | Service. If     |               |   |                            |
|   | your            |               |   |                            |
|   | organization is |               |   |                            |
|   | not in the US,  |               |   |                            |
|   | enter           |               |   |                            |
|   | 44-4444444.     |               |   |                            |
+---+-----------------+---------------+---+----------------------------+
|   |                 |               | 1 | **Estimated Funding:**     |
|   |                 |               | 8 | (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.            |               |   |                            |
|   | Organizational  |               |   |                            |
|   | DUNS**:         |               |   |                            |
|   | (Required)      |               |   |                            |
|   | Enter the       |               |   |                            |
|   | organization'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). |               |   |                            |
+---+-----------------+---------------+---+----------------------------+
|   |                 |               | 1 | **Is Application Subject   |
|   |                 |               | 9 | 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.            |               |   |                            |
|   | Organizational  |               |   |                            |
|   | Unit:** Enter   |               |   |                            |
|   | the name of the |               |   |                            |
|   | primary         |               |   |                            |
|   | organizational  |               |   |                            |
|   | unit (and       |               |   |                            |
|   | department or   |               |   |                            |
|   | division, if    |               |   |                            |
|   | applicable**)** |               |   |                            |
|   | that will       |               |   |                            |
|   | undertake the   |               |   |                            |
|   | assistance      |               |   |                            |
|   | activity, if    |               |   |                            |
|   | applicable.     |               |   |                            |
+---+-----------------+---------------+---+----------------------------+
|   |                 |               |   |                            |
+---+-----------------+---------------+---+----------------------------+
|   |                 |               |   |                            |
+---+-----------------+---------------+---+----------------------------+
|   | **f. Name and   |               |   |                            |
|   | contact         |               |   |                            |
|   | information of  |               |   |                            |
|   | person to be    |               |   |                            |
|   | contacted on    |               |   |                            |
|   | matters         |               |   |                            |
|   | involving this  |               |   |                            |
|   | application**:  |               |   |                            |
|   | Enter the name  |               |   |                            |
|   | (First and last |               |   |                            |
|   | name required), |               |   |                            |
|   | organizational  |               |   |                            |
|   | affiliation (if |               |   |                            |
|   | affiliated with |               |   |                            |
|   | an organization |               |   |                            |
|   | other than the  |               |   |                            |
|   | applicant       |               |   |                            |
|   | organization),  |               |   |                            |
|   | telephone       |               |   |                            |
|   | number          |               |   |                            |
|   | (Required), fax |               |   |                            |
|   | number, and     |               |   |                            |
|   | email address   |               |   |                            |
|   | (Required) of   |               |   |                            |
|   | the person to   |               |   |                            |
|   | contact on      |               |   |                            |
|   | matters related |               |   |                            |
|   | to this         |               |   |                            |
|   | application.    |               |   |                            |
+---+-----------------+---------------+---+----------------------------+
|   |                 |               | 2 | **Is the Applicant         |
|   |                 |               | 0 | 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         |               | 2 | **Authorized               |
| \ | Applicant:      |               | 1 | Representative**:          |
| . | (Required)      |               | \ | (Required) To be signed    |
|   |                 |               | . | and dated by the           |
|   | Select up to    |               |   | authorized representative  |
|   | three applicant |               |   | of the applicant           |
|   | type(s) in      |               |   | organization. Enter the    |
|   | accordance with |               |   | name (First and last name  |
|   | agency          |               |   | required) title            |
|   | instructions.   |               |   | (Required), telephone      |
|   |                 |               |   | number (Required), fax     |
|   |                 |               |   | number, and email address  |
|   |                 |               |   | (Required) of 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 IRS |   |                            |
|   | ```{=html}      |     Status    |   |                            |
|   | <!-- -->        |     (Other    |   |                            |
|   | ```             |     than      |   |                            |
|   | A.  County      |               |   |                            |
|   |     Government  |   Institution |   |                            |
|   |                 |     of Higher |   |                            |
|   | B.  City or     |               |   |                            |
|   |     Township    |    Education) |   |                            |
|   |     Government  |               |   |                            |
|   |                 | M.  Nonprofit |   |                            |
|   | C.  Special     |     without   |   |                            |
|   |     District    |     501C3 IRS |   |                            |
|   |     Government  |     Status    |   |                            |
|   |                 |     (Other    |   |                            |
|   | D.  Regional    |     than      |   |                            |
|   |                 |               |   |                            |
|   |    Organization |   Institution |   |                            |
|   |                 |     of Higher |   |                            |
|   | E.  U.S.        |               |   |                            |
|   |     Territory   |    Education) |   |                            |
|   |     or          |               |   |                            |
|   |     Possession  | N.  Private   |   |                            |
|   |                 |               |   |                            |
|   | F.  Independent |   Institution |   |                            |
|   |     School      |     of Higher |   |                            |
|   |     District    |     Education |   |                            |
|   |                 |               |   |                            |
|   | G               | O             |   |                            |
|   | .  Public/State | .  Individual |   |                            |
|   |     Controlled  |               |   |                            |
|   |     Institution | P             |   |                            |
|   |     of Higher   | .  For-Profit |   |                            |
|   |     Education   |               |   |                            |
|   |                 |  Organization |   |                            |
|   | H.              |     (Other    |   |                            |
|   |   Indian/Native |     than      |   |                            |
|   |     American    |     Small     |   |                            |
|   |     Tribal      |     Business) |   |                            |
|   |     Government  |               |   |                            |
|   |     (Federally  | Q.  Small     |   |                            |
|   |     Recognized) |     Business  |   |                            |
|   |                 |               |   |                            |
|   | I.              | R.  His       |   |                            |
|   |   Indian/Native | panic-serving |   |                            |
|   |     American    |               |   |                            |
|   |     Tribal      |   Institution |   |                            |
|   |     Government  |               |   |                            |
|   |     (Other than | S.            |   |                            |
|   |     Federally   |  Historically |   |                            |
|   |     Recognized) |     Black     |   |                            |
|   |                 |     Colleges  |   |                            |
|   | J.              |     and       |   |                            |
|   |   Indian/Native |               |   |                            |
|   |     American    |  Universities |   |                            |
|   |     Tribally    |     (HBCUs)   |   |                            |
|   |     Designated  |               |   |                            |
|   |                 | T.  Tribally  |   |                            |
|   |    Organization |               |   |                            |
|   |                 |    Controlled |   |                            |
|   | K.              |     Colleges  |   |                            |
|   |   Public/Indian |     and       |   |                            |
|   |     Housing     |               |   |                            |
|   |     Authority   |  Universities |   |                            |
|   |                 |     (TCCUs)   |   |                            |
|   |                 |               |   |                            |
|   |                 | U.  Alaska    |   |                            |
|   |                 |     Native    |   |                            |
|   |                 |     and       |   |                            |
|   |                 |     Native    |   |                            |
|   |                 |     Hawaiian  |   |                            |
|   |                 |     Serving   |   |                            |
|   |                 |               |   |                            |
|   |                 |  Institutions |   |                            |
|   |                 |               |   |                            |
|   |                 | 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 subgrant 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]{.underline}** 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 for ED 524**

[General Instructions]{.underline}

This form is used to apply to individual U.S. Department of Education
(ED) discretionary grant programs. Unless directed otherwise, provide
the same budget information for each year of the multi-year funding
request. Pay attention to applicable program specific instructions, if
attached. Please consult with your Business Office prior to submitting
this form.

[Section A - Budget Summary]{.underline}

[U.S. Department of Education Funds]{.underline}

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

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

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

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

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

Indirect Cost Information:\
If you are requesting reimbursement for indirect costs on line 10, 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.

[Section B - Budget Summary]{.underline}

[Non-Federal Funds]{.underline}

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

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

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

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

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

[Section C - Budget Narrative \[Attach separate sheet(s)\]]{.underline}

[Pay attention to applicable program specific instructions,\
if attached.]{.underline}

1\. Provide an itemized budget breakdown, and justification by project
year, for each budget category listed in Sections A and B. For grant
projects that will be divided into two or more separately budgeted major
activities or sub-projects, show for each budget category of a project
year the breakdown of the specific expenses attributable to each
sub-project or activity.

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

3\. If you are requesting reimbursement for indirect costs on line 10,
this information is to be completed by your Business Office. Specify the
estimated amount of the

base to which the indirect cost rate is applied and the total indirect
expense. Depending on the grant program to which you are applying and/or
your approved Indirect Cost Rate Agreement, some direct cost budget
categories in your grant application budget may not be included in the
base and multiplied by your indirect cost rate. For example, you must
multiply the indirect cost rates of "Training grants\" (34 CFR 75.562)
and grants under programs with "Supplement not Supplant" requirements
(\"Restricted Rate\" programs) by a "modified total direct cost" (MTDC)
base (34 CFR 75.563 or 76.563). Please indicate which costs are included
and which costs are excluded from the base to which the indirect cost
rate is applied.

> When calculating indirect costs (line 10) for \"Training grants\" or
> grants under \"Restricted Rate\" programs, you must refer to the
> information and examples on ED's website at:
> [http://www.ed.gov/fund/grant/apply/appforms/appforms.html]{.underline}.
>
> You may also contact (202) 377-3838 for additional information
> regarding calculating indirect cost rates or general indirect cost
> rate information.

4\. Provide other explanations or comments you deem necessary.

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 **1890-0004**. The time
required to complete this information collection is estimated to vary
from 13 to 22 hours per response, with an average of 17.5 hours per
response, including the time to review instructions, search existing
data sources, 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, DC 20202-4651. If
you have comments or concerns regarding the status of your individual
submission of this form, write directly to (insert program office), U.S.
Department of Education, 400 Maryland Avenue, S.W., Washington, DC
20202.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

**84.031A Strengthening Institutions Program Profile**

**[INSTRUCTIONS]{.underline}**: *ALL applicants must complete these
pages. The completed pages must be attached to the "Other Attachments
Form" in the application package in Grants.gov (as either a .doc, .rtf,
or. pdf document). [DO NOT MODIFY OR AMEND THESE PAGES]{.underline}.*

OPE ID #\_\_\_\_\_\_\_\_\_\_\_

**1. INSTITUTION (Legal Name):**

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

**2. Are you applying as a Branch Campus? \_\_\_\_\_YES \_\_\_\_\_NO**

**3. ADDRESS (Applicants must indicate the address where the project
will be located):**

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

City:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_State:
\_\_\_\_\_\_Zip: \_\_\_\_\_\_\_\_\_\_\_\_\_

**4.** **ENDOWMENT FUND ASSURANCE:**

**By checking this box (or placing an "X" beside it)**, an applicant
certifies that the institution of higher education proposes to use up to
twenty percent (20%) of the Strengthening Institutions Program grant
award, made under the authority of Title III, Part A of the Higher
Education Act of 1965, as amended, to establish or increase the
institution's endowment fund. The institution agrees to abide by the
Department of Education's regulations governing the Endowment Challenge
Grant Program, 34 CFR Part 628, the program statute, and the program
regulations, 34 CFR Part 607. The institution further agrees to raise
the required matching funds.

**5.** **DUAL SUBMISSION CERTIFICATION:** If an institution applies for
more than one grant, it must indicate which grant it wishes to receive
if it is selected to receive more than one.

If my institution should be selected to receive more than one grant, I
will accept the

grant
for\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(insert
name of program).

**6.** **COOPERATIVE ARRANGEMENT FOR PARTICIPATING INSTITUTIONS:** The
applicant institution [must]{.underline} provide for each Participating
Institution: the Institution Name, DUNS Number, Location (City and
State).

**84.031N Alaska Native Program Profile**

**[INSTRUCTIONS]{.underline}**: *ALL applicants must complete these
pages. The completed pages must be attached to the "Other Attachments
Form" in the application package in Grants.gov (as either a .doc, .rtf
or. pdf document). [DO NOT MODIFY OR AMEND THESE PAGES]{.underline}.*

OPE ID #\_\_\_\_\_\_\_\_\_\_\_

**1. INSTITUTION (Legal Name):**

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

**2. Are you applying as a Branch Campus? \_\_\_\_\_YES \_\_\_\_\_NO**

**3. ADDRESS (Applicants must indicate the address where the project
will be located):**

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

City:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_State:
\_\_\_\_\_\_Zip: \_\_\_\_\_\_\_\_\_\_\_\_\_

**4.** **ALASKA NATIVE-SERVING INSTITUTIONS CERTIFICATION:**

**By checking this box (or placing an "X" beside it)**, the applicant
certifies pursuant to the statutory requirements governing the Alaska
Native-Serving Institutions Program, authorized under Title III, Part A
of the Higher Education Act of 1965, as amended, that:

The named institution of higher education, at the time of application,
has an enrollment of undergraduate students that is at least twenty
percent (20%) Alaska Native. The term "Native" means "a citizen of the
United States who is a person of one-fourth degree or more Alaska Indian
(including Tsimshian Indians not enrolled in the Metlaktla Indian
Community) Eskimo, or Aleut blood, or combination thereof. The term
includes any Native as so defined either or both of whose adoptive
parents are not Natives. It also includes, in the absence of proof of a
minimum blood quantum, any citizen of the United States who is regarded
as an Alaska Native by the Native village or Native group of which he
claims to be a member and whose father or mother is (or, if deceased,
was) regarded as Native by any village or group." (See Section 1602 of
the "Alaska Native Claims Settlement Act," as codified)

Specifically:

Total Undergraduate Headcount Enrollment: \_\_\_\_\_\_\_\_\_\_\_

Alaska Native Undergraduate Headcount Enrollment: \_\_\_\_\_\_\_\_\_\_\_

::: Definition-Term
Percent of Alaska Native Enrollment of Undergraduate Students:
\_\_\_\_\_\_\_\_\_\_\_
:::

**5.** **COOPERATIVE ARRANGEMENT FOR PARTICIPATING INSTITUTIONS:** The
applicant institution [must]{.underline} provide for each Participating
Institution: the Institution Name, DUNS Number, Location (City and
State).

**84.031T Tribally Controlled Colleges and Universities Program
Profile**

**[INSTRUCTIONS]{.underline}**: *ALL applicants must complete these
pages. The completed pages must be attached to the "Other Attachments
Form" in the application package in Grants.gov (as either a .doc, .rtf
or. pdf document). [DO NOT MODIFY OR AMEND THESE PAGES]{.underline}.*

OPE ID #\_\_\_\_\_\_\_\_\_\_\_\_\_

**1. INSTITUTION (Legal Name):**

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

**2. Are you applying as a Branch Campus? \_\_\_\_\_YES \_\_\_\_\_NO**

**3. ADDRESS (Applicants must indicate the address where the project
will be located):**

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

City:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_State:
\_\_\_\_\_\_Zip: \_\_\_\_\_\_\_\_\_\_\_\_\_

**4.** **ENDOWMENT FUND ASSURANCE:**

**By checking this box (or placing an "X" beside it)**, an applicant
certifies that the institution of higher education proposes to use up to
twenty percent (20%) of the Strengthening Institutions Program grant
award, made under the authority of Title III, Part A of the Higher
Education Act of 1965, as amended, to establish or increase the
institution's endowment fund. The institution agrees to abide by the
Department of Education's regulations governing the Endowment Challenge
Grant Program, 34 CFR Part 628, the program statute, and the program
regulations, 34 CFR Part 607. The institution further agrees to raise
the required matching funds.

**5.** **COOPERATIVE ARRANGEMENT FOR PARTICIPATING INSTITUTIONS:** The
applicant institution [must]{.underline} provide for each Participating
Institution: the Institution Name, DUNS Number, Location (City and
State).

**84.031W Native Hawaiian-Serving Institutions** **Program Profile**

**[INSTRUCTIONS]{.underline}**: *ALL applicants must complete these
pages. The completed pages must be attached to the "Other Attachments
Form" in the application package in Grants.gov (as either a .doc, .rtf
or. pdf document). [DO NOT MODIFY OR AMEND THESE PAGES]{.underline}.*

OPE ID #\_\_\_\_\_\_\_\_\_\_\_

**1. INSTITUTION (Legal Name):**

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

**2. Are you applying as a Branch Campus? \_\_\_\_\_YES \_\_\_\_\_NO**

**3. ADDRESS (Applicants must indicate the address where the project
will be located):**

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

City:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_State:
\_\_\_\_\_\_Zip: \_\_\_\_\_\_\_\_\_\_\_\_\_

**4.** **NATIVE HAWAIIAN-SERVING INSTITUTIONS CERTIFICATION:**

-   **By checking this box (or placing an "X" beside it)**, the
    applicant certifies pursuant to the statutory requirements governing
    the Alaska Native and Native Hawaiian-Serving Institutions Program,
    authorized under Title III, Part A of the Higher Education Act of
    1965, as amended, that:

The institution of higher education, at the time of application, has an
enrollment of undergraduate students that is at least ten percent (10%)
Native Hawaiian. The term "Native Hawaiian" means any individual who is
---

\(A\) a citizen of the United States; and

\(B\) a descendant of the aboriginal people who, prior to 1778, occupied
and exercised sovereignty in the area that now comprises the State of
Hawaii, as evidenced by ---

\(i\) genealogical records;

> \(ii\) Kupuna (elders) or Kamaaina (long-term community residents)
> verification; or

\(iii\) certified birth records.

(See Section 317(b) (3), of the HEA)

Specifically:

Total Undergraduate Headcount Enrollment: \_\_\_\_\_\_\_\_\_\_\_\_

Native Hawaiian Undergraduate Headcount Enrollment:
\_\_\_\_\_\_\_\_\_\_\_\_

Percent of Native Hawaiian Enrollment of Undergraduate Students:
\_\_\_\_\_\_\_\_\_\_\_\_

**5.** **COOPERATIVE ARRANGEMENT FOR PARTICIPATING INSTITUTIONS:** The
applicant institution [must]{.underline} provide for each Participating
Institution: the Institution Name, DUNS Number, Location (City and
State).

FORMS

<table style="width:100%;">
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</colgroup>
<tbody>
<tr class="odd">
<td colspan="6"><h1 id="application-for"> APPLICATION FOR</h1></td>
<td colspan="3"></td>
<td></td>
<td colspan="7"></td>
<td colspan="4">Version 9/03</td>
</tr>
<tr class="even">
<td colspan="9"><h3 id="federal-assistance">FEDERAL ASSISTANCE</h3></td>
<td></td>
<td colspan="7"><strong>2. DATE SUBMITTED</strong></td>
<td colspan="4">Applicant Identifier</td>
</tr>
<tr class="odd">
<td colspan="3"><strong>1. TYPE OF SUBMISSION:</strong></td>
<td colspan="7"></td>
<td colspan="7" rowspan="2"><strong>3. DATE RECEIVED BY
STATE</strong></td>
<td colspan="4" rowspan="2">State Application Identifier</td>
</tr>
<tr class="even">
<td colspan="3">Application</td>
<td colspan="7">Pre-application</td>
</tr>
<tr class="odd">
<td colspan="3"><strong>Construction</strong></td>
<td colspan="7"><strong>Construction</strong></td>
<td colspan="7" rowspan="2"><strong>4. DATE RECEIVED BY FEDERAL
AGENCY</strong></td>
<td colspan="4" rowspan="2">Federal Identifier</td>
</tr>
<tr class="even">
<td colspan="3"><strong>Non-Construction</strong></td>
<td colspan="7"><strong>Non-Construction</strong></td>
</tr>
<tr class="odd">
<td colspan="21"><strong>5. APPLICANT INFORMATION</strong></td>
</tr>
<tr class="even">
<td colspan="14" rowspan="2">Legal Name:</td>
<td colspan="7"><strong>Organizational Unit</strong>:</td>
</tr>
<tr class="odd">
<td colspan="7">Department:</td>
</tr>
<tr class="even">
<td colspan="14">Organizational DUNS:</td>
<td colspan="7">Division:</td>
</tr>
<tr class="odd">
<td colspan="14"><strong>Address</strong>:</td>
<td colspan="7" rowspan="2"><p><strong>Name and telephone number of
person to be contacted on matters</strong></p>
<p><strong>involving this application (give area code</strong>)</p></td>
</tr>
<tr class="even">
<td colspan="14">Street:</td>
</tr>
<tr class="odd">
<td colspan="14"></td>
<td colspan="3">Prefix:</td>
<td colspan="4">First Name:</td>
</tr>
<tr class="even">
<td colspan="14">City:</td>
<td colspan="7">Middle Name</td>
</tr>
<tr class="odd">
<td colspan="14">County:</td>
<td colspan="7">Last Name</td>
</tr>
<tr class="even">
<td colspan="4">State:</td>
<td colspan="10">Zip Code</td>
<td colspan="7">Suffix:</td>
</tr>
<tr class="odd">
<td colspan="14">Country:</td>
<td colspan="7">Email:</td>
</tr>
<tr class="even">
<td colspan="14"><p><strong>6. EMPLOYER IDENTIFICATION NUMBER</strong>
<em>(EIN):</em></p>
<p>-</p></td>
<td colspan="5">Phone Number (give area code)</td>
<td colspan="2">Fax Number (give area code)</td>
</tr>
<tr class="odd">
<td colspan="14"><strong>8. TYPE OF APPLICATION:</strong></td>
<td colspan="7" rowspan="2"><strong>7. TYPE OF APPLICANT: (</strong>See
back of form for Application Types)</td>
</tr>
<tr class="even">
<td></td>
<td colspan="6"><strong>New</strong></td>
<td colspan="4"><strong>Continuation</strong></td>
<td colspan="3"><strong>Revision</strong></td>
</tr>
<tr class="odd">
<td colspan="8">If Revision, enter appropriate letter(s) in box(es)</td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="7"></td>
</tr>
<tr class="even">
<td colspan="8">(See back of form for description of letters.)</td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="7">Other (specify)</td>
</tr>
<tr class="odd">
<td colspan="14">Other (specify)</td>
<td colspan="7"><strong>9. NAME OF FEDERAL AGENCY:</strong></td>
</tr>
<tr class="even">
<td colspan="14"><strong>10.</strong> <strong>CATALOG OF FEDERAL
DOMESTIC ASSISTANCE NUMBER:</strong></td>
<td colspan="7" rowspan="4"><strong>11. DESCRIPTIVE TITLE OF APPLICANT’S
PROJECT:</strong></td>
</tr>
<tr class="odd">
<td colspan="13">-</td>
<td></td>
</tr>
<tr class="even">
<td colspan="14">TITLE (Name of Program):</td>
</tr>
<tr class="odd">
<td colspan="14"><strong>12. AREAS AFFECTED BY PROJECT</strong>
<em>(Cities, Counties, States, etc.):</em></td>
</tr>
<tr class="even">
<td colspan="14"></td>
<td colspan="7"></td>
</tr>
<tr class="odd">
<td colspan="14"><strong>13. PROPOSED PROJECT</strong></td>
<td colspan="7"><strong>14. CONGRESSIONAL DISTRICTS OF:</strong></td>
</tr>
<tr class="even">
<td colspan="5">Start Date:</td>
<td colspan="9">Ending Date:</td>
<td colspan="5">a. Applicant</td>
<td colspan="2">b. Project</td>
</tr>
<tr class="odd">
<td colspan="14"><strong>15. ESTIMATED FUNDING:</strong></td>
<td colspan="7"><strong>16. IS APPLICATION SUBJECT TO REVIEW BY STATE
EXECUTIVE ORDER 12372 PROCESS?</strong></td>
</tr>
<tr class="even">
<td colspan="2">a. Federal</td>
<td colspan="10">$</td>
<td colspan="2">.<sup>00</sup></td>
<td rowspan="2">a. Yes.</td>
<td colspan="6" rowspan="2">THIS PREAPPLICATION/APPLICATION WAS MADE
Available TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON</td>
</tr>
<tr class="odd">
<td colspan="2">b. Applicant</td>
<td colspan="10">$</td>
<td colspan="2">.<sup>00</sup></td>
</tr>
<tr class="even">
<td colspan="2">c. State</td>
<td colspan="10">$</td>
<td colspan="2">.<sup>00</sup></td>
<td></td>
<td colspan="6">DATE:</td>
</tr>
<tr class="odd">
<td colspan="2">d. Local</td>
<td colspan="10">$</td>
<td colspan="2">.<sup>00</sup></td>
<td>b. No.</td>
<td colspan="6">PROGRAM IS NOT COVERED BY E. O. 12372</td>
</tr>
<tr class="even">
<td colspan="2">e. Other</td>
<td colspan="10">$</td>
<td colspan="2">.<sup>00</sup></td>
<td></td>
<td colspan="6">OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR
REVIEW</td>
</tr>
<tr class="odd">
<td colspan="2">f. Program Income</td>
<td colspan="10">$</td>
<td colspan="2">.<sup>00</sup></td>
<td colspan="7"><strong>17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL
DEBT?</strong></td>
</tr>
<tr class="even">
<td colspan="2">g. TOTAL</td>
<td colspan="10">$</td>
<td colspan="2">.<sup>00</sup></td>
<td colspan="6">Yes If “Yes” attach an explanation.</td>
<td>No</td>
</tr>
<tr class="odd">
<td colspan="21"><strong>18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL
DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT. THE
DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT
AND THE APPLICANT WILL COMPLY WITH THE ATTACHED
ASSURANCES.</strong></td>
</tr>
<tr class="even">
<td colspan="21">a. Authorized Representative</td>
</tr>
<tr class="odd">
<td colspan="4">Prefix</td>
<td colspan="12">First Name</td>
<td colspan="5">Middle Name</td>
</tr>
<tr class="even">
<td colspan="16">Last Name</td>
<td colspan="5">Suffix</td>
</tr>
<tr class="odd">
<td colspan="16">b. Title</td>
<td colspan="5">c. Telephone Number (give area code)</td>
</tr>
<tr class="even">
<td colspan="16">Email:</td>
<td colspan="5">Fax Number (give area code)</td>
</tr>
<tr class="odd">
<td colspan="16">d. Signature of Authorized Representative</td>
<td colspan="5">e. Date Signed</td>
</tr>
<tr class="even">
<td colspan="18">Previous Edition Usable</td>
<td colspan="3">Standard Form 424 (Rev. x-xx)</td>
</tr>
<tr class="odd">
<td colspan="18">Authorized for Local Reproduction</td>
<td colspan="3">Prescribed by OMB Circular A-102</td>
</tr>
</tbody>
</table>

######### SUPPLEMENTAL INFORMATION

**REQUIRED FOR**

**DEPARTMENT OF EDUCATION**

**1. [Project Director:]{.underline}**

Prefix: \*First Name: Middle Name: \*Last Name: Suffix:

Address:

\* Street1:

Street2:

\* City:

County:

\* State \* Zip Code: \* Country:

\* Phone Number (give area code) Fax Number (give area code)

Email Address:

**2. [Applicant Experience:]{.underline}**

Novice Applicant Yes No Not applicable to this program

**3. [Human Subjects Research:]{.underline}**

Are any research activities involving human subjects planned at any time
during the

proposed project Period?

Yes No

Are ALL the research activities proposed designated to be exempt from
the regulations?

![](media/image2.wmf){width="0.12013888888888889in"
height="0.12013888888888889in"}

Yes Provide Exemption(s) #:

![](media/image2.wmf){width="0.12013888888888889in"
height="0.12013888888888889in"}

No Provide Assurance #, if available:

**[Please attach an explanation Narrative:]{.underline}**

+---------+----+--------+--------+--------+--------+---+-----+---------+
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|         | TI |        |        |        |        |   | rat |         |
|         | ON |        |        |        |        |   | ion |         |
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|         | #  |        |        |        |        |   | te: |         |
|         | BU |        |        |        |        |   | 1   |         |
|         | DG |        |        |        |        |   | 0-3 |         |
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|         | NF |        |        |        |        |   |     |         |
|         | OR |        |        |        |        |   |     |         |
|         | MA |        |        |        |        |   |     |         |
|         | TI |        |        |        |        |   |     |         |
|         | ON |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
|         | #  |        |        |        |        |   |     |         |
|         | NO |        |        |        |        |   |     |         |
|         | N- |        |        |        |        |   |     |         |
|         | CO |        |        |        |        |   |     |         |
|         | NS |        |        |        |        |   |     |         |
|         | TR |        |        |        |        |   |     |         |
|         | UC |        |        |        |        |   |     |         |
|         | TI |        |        |        |        |   |     |         |
|         | ON |        |        |        |        |   |     |         |
|         |  P |        |        |        |        |   |     |         |
|         | RO |        |        |        |        |   |     |         |
|         | GR |        |        |        |        |   |     |         |
|         | AM |        |        |        |        |   |     |         |
|         | S  |        |        |        |        |   |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+
| > Name  |    |        |        | Appl   |        |   |     |         |
| > of    |    |        |        | icants |        |   |     |         |
| > Ins   |    |        |        | requ   |        |   |     |         |
| titutio |    |        |        | esting |        |   |     |         |
| n/Organ |    |        |        | f      |        |   |     |         |
| ization |    |        |        | unding |        |   |     |         |
|         |    |        |        | for    |        |   |     |         |
|         |    |        |        | only   |        |   |     |         |
|         |    |        |        | one    |        |   |     |         |
|         |    |        |        | year   |        |   |     |         |
|         |    |        |        | should |        |   |     |         |
|         |    |        |        | co     |        |   |     |         |
|         |    |        |        | mplete |        |   |     |         |
|         |    |        |        | the    |        |   |     |         |
|         |    |        |        | column |        |   |     |         |
|         |    |        |        | under  |        |   |     |         |
|         |    |        |        | \"P    |        |   |     |         |
|         |    |        |        | roject |        |   |     |         |
|         |    |        |        | Year   |        |   |     |         |
|         |    |        |        | 1.\"   |        |   |     |         |
|         |    |        |        | Appl   |        |   |     |         |
|         |    |        |        | icants |        |   |     |         |
|         |    |        |        | requ   |        |   |     |         |
|         |    |        |        | esting |        |   |     |         |
|         |    |        |        | f      |        |   |     |         |
|         |    |        |        | unding |        |   |     |         |
|         |    |        |        | for    |        |   |     |         |
|         |    |        |        | mult   |        |   |     |         |
|         |    |        |        | i-year |        |   |     |         |
|         |    |        |        | grants |        |   |     |         |
|         |    |        |        | should |        |   |     |         |
|         |    |        |        | co     |        |   |     |         |
|         |    |        |        | mplete |        |   |     |         |
|         |    |        |        | all    |        |   |     |         |
|         |    |        |        | appl   |        |   |     |         |
|         |    |        |        | icable |        |   |     |         |
|         |    |        |        | co     |        |   |     |         |
|         |    |        |        | lumns. |        |   |     |         |
|         |    |        |        | Please |        |   |     |         |
|         |    |        |        | read   |        |   |     |         |
|         |    |        |        | all    |        |   |     |         |
|         |    |        |        | instru |        |   |     |         |
|         |    |        |        | ctions |        |   |     |         |
|         |    |        |        | before |        |   |     |         |
|         |    |        |        | comp   |        |   |     |         |
|         |    |        |        | leting |        |   |     |         |
|         |    |        |        | form.  |        |   |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+
| **      |    |        |        |        |        |   |     |         |
| SECTION |    |        |        |        |        |   |     |         |
| A -     |    |        |        |        |        |   |     |         |
| BUDGET  |    |        |        |        |        |   |     |         |
| SU      |    |        |        |        |        |   |     |         |
| MMARY** |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
| ##      |    |        |        |        |        |   |     |         |
|  U.S. D |    |        |        |        |        |   |     |         |
| EPARTME |    |        |        |        |        |   |     |         |
| NT OF E |    |        |        |        |        |   |     |         |
| DUCATIO |    |        |        |        |        |   |     |         |
| N FUNDS |    |        |        |        |        |   |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+
| Budget  |    | P      | P      | P      | P      | P |     | Total   |
| Cat     |    | roject | roject | roject | roject | r |     |         |
| egories |    | Year 1 | Year 2 | Year 3 | Year 4 | o |     | \(f\)   |
|         |    |        |        |        |        | j |     |         |
|         |    | \(a\)  | \(b\)  | \(c\)  | \(d\)  | e |     |         |
|         |    |        |        |        |        | c |     |         |
|         |    |        |        |        |        | t |     |         |
|         |    |        |        |        |        | Y |     |         |
|         |    |        |        |        |        | e |     |         |
|         |    |        |        |        |        | a |     |         |
|         |    |        |        |        |        | r |     |         |
|         |    |        |        |        |        | 5 |     |         |
|         |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        | \ |     |         |
|         |    |        |        |        |        | ( |     |         |
|         |    |        |        |        |        | e |     |         |
|         |    |        |        |        |        | \ |     |         |
|         |    |        |        |        |        | ) |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+
| 1\.     |    |        |        |        |        |   |     |         |
| Pe      |    |        |        |        |        |   |     |         |
| rsonnel |    |        |        |        |        |   |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+
| 2\.     |    |        |        |        |        |   |     |         |
| Fringe  |    |        |        |        |        |   |     |         |
| B       |    |        |        |        |        |   |     |         |
| enefits |    |        |        |        |        |   |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+
| 3\.     |    |        |        |        |        |   |     |         |
| Travel  |    |        |        |        |        |   |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+
| 4\.     |    |        |        |        |        |   |     |         |
| Eq      |    |        |        |        |        |   |     |         |
| uipment |    |        |        |        |        |   |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+
| 5\.     |    |        |        |        |        |   |     |         |
| S       |    |        |        |        |        |   |     |         |
| upplies |    |        |        |        |        |   |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+
| 6\.     |    |        |        |        |        |   |     |         |
| Cont    |    |        |        |        |        |   |     |         |
| ractual |    |        |        |        |        |   |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+
| 7\.     |    |        |        |        |        |   |     |         |
| Const   |    |        |        |        |        |   |     |         |
| ruction |    |        |        |        |        |   |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+
| 8\.     |    |        |        |        |        |   |     |         |
| Other   |    |        |        |        |        |   |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+
| 9\.     |    |        |        |        |        |   |     |         |
| Total   |    |        |        |        |        |   |     |         |
| Direct  |    |        |        |        |        |   |     |         |
| Costs   |    |        |        |        |        |   |     |         |
| (lines  |    |        |        |        |        |   |     |         |
| 1-8)    |    |        |        |        |        |   |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+
| 10\.    |    | XXXXXX | XXXXXX | XXXXXX | XXXXXX | X |     | XXXXXX  |
| I       |    | XXXXXX | XXXXXX | XXXXXX | XXXXXX | X |     | XXXXXXX |
| ndirect |    |        |        |        |        | X |     |         |
| Costs\* |    |        |        |        |        | X |     |         |
|         |    |        |        |        |        | X |     |         |
|         |    |        |        |        |        | X |     |         |
|         |    |        |        |        |        | X |     |         |
|         |    |        |        |        |        | X |     |         |
|         |    |        |        |        |        | X |     |         |
|         |    |        |        |        |        | X |     |         |
|         |    |        |        |        |        | X |     |         |
|         |    |        |        |        |        | X |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+
| 11\.    |    |        |        |        |        |   |     |         |
| T       |    |        |        |        |        |   |     |         |
| raining |    |        |        |        |        |   |     |         |
| S       |    |        |        |        |        |   |     |         |
| tipends |    |        |        |        |        |   |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+
| 12\.    |    |        |        |        |        |   |     |         |
| Total   |    |        |        |        |        |   |     |         |
| Costs   |    |        |        |        |        |   |     |         |
| (lines  |    |        |        |        |        |   |     |         |
| 9-11)   |    |        |        |        |        |   |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+
| > **\*I |    |        |        |        |        |   |     |         |
| ndirect |    |        |        |        |        |   |     |         |
| > Cost  |    |        |        |        |        |   |     |         |
| > Info  |    |        |        |        |        |   |     |         |
| rmation |    |        |        |        |        |   |     |         |
| > *(To  |    |        |        |        |        |   |     |         |
| > Be    |    |        |        |        |        |   |     |         |
| > Co    |    |        |        |        |        |   |     |         |
| mpleted |    |        |        |        |        |   |     |         |
| > by    |    |        |        |        |        |   |     |         |
| > Your  |    |        |        |        |        |   |     |         |
| > B     |    |        |        |        |        |   |     |         |
| usiness |    |        |        |        |        |   |     |         |
| > Of    |    |        |        |        |        |   |     |         |
| fice*): |    |        |        |        |        |   |     |         |
| > Leave |    |        |        |        |        |   |     |         |
| >       |    |        |        |        |        |   |     |         |
|  blank. |    |        |        |        |        |   |     |         |
| > Title |    |        |        |        |        |   |     |         |
| > III,  |    |        |        |        |        |   |     |         |
| > Part  |    |        |        |        |        |   |     |         |
| > A     |    |        |        |        |        |   |     |         |
| > does  |    |        |        |        |        |   |     |         |
| > not   |    |        |        |        |        |   |     |         |
| > allow |    |        |        |        |        |   |     |         |
| > i     |    |        |        |        |        |   |     |         |
| ndirect |    |        |        |        |        |   |     |         |
| > c     |    |        |        |        |        |   |     |         |
| osts.** |    |        |        |        |        |   |     |         |
| >       |    |        |        |        |        |   |     |         |
| > If    |    |        |        |        |        |   |     |         |
| > you   |    |        |        |        |        |   |     |         |
| > are   |    |        |        |        |        |   |     |         |
| > req   |    |        |        |        |        |   |     |         |
| uesting |    |        |        |        |        |   |     |         |
| >       |    |        |        |        |        |   |     |         |
|  reimbu |    |        |        |        |        |   |     |         |
| rsement |    |        |        |        |        |   |     |         |
| > for   |    |        |        |        |        |   |     |         |
| > i     |    |        |        |        |        |   |     |         |
| ndirect |    |        |        |        |        |   |     |         |
| > costs |    |        |        |        |        |   |     |         |
| > on    |    |        |        |        |        |   |     |         |
| > line  |    |        |        |        |        |   |     |         |
| > 10,   |    |        |        |        |        |   |     |         |
| >       |    |        |        |        |        |   |     |         |
|  please |    |        |        |        |        |   |     |         |
| >       |    |        |        |        |        |   |     |         |
|  answer |    |        |        |        |        |   |     |         |
| > the   |    |        |        |        |        |   |     |         |
| > fo    |    |        |        |        |        |   |     |         |
| llowing |    |        |        |        |        |   |     |         |
| > que   |    |        |        |        |        |   |     |         |
| stions: |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
| (1) Do  |    |        |        |        |        |   |     |         |
|     you |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
|    have |    |        |        |        |        |   |     |         |
|     an  |    |        |        |        |        |   |     |         |
|     I   |    |        |        |        |        |   |     |         |
| ndirect |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
|    Cost |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
|    Rate |    |        |        |        |        |   |     |         |
|     Ag  |    |        |        |        |        |   |     |         |
| reement |    |        |        |        |        |   |     |         |
|     a   |    |        |        |        |        |   |     |         |
| pproved |    |        |        |        |        |   |     |         |
|     by  |    |        |        |        |        |   |     |         |
|     the |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
| Federal |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
|    gove |    |        |        |        |        |   |     |         |
| rnment? |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
|    \_\_ |    |        |        |        |        |   |     |         |
| \_\_Yes |    |        |        |        |        |   |     |         |
|     \   |    |        |        |        |        |   |     |         |
| _\_\_\_ |    |        |        |        |        |   |     |         |
|     No  |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
| (2) If  |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
|    yes, |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
|  please |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
| provide |    |        |        |        |        |   |     |         |
|     the |    |        |        |        |        |   |     |         |
|     fo  |    |        |        |        |        |   |     |         |
| llowing |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
|   infor |    |        |        |        |        |   |     |         |
| mation: |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
| >       |    |        |        |        |        |   |     |         |
|  Period |    |        |        |        |        |   |     |         |
| >       |    |        |        |        |        |   |     |         |
| Covered |    |        |        |        |        |   |     |         |
| > by    |    |        |        |        |        |   |     |         |
| > the   |    |        |        |        |        |   |     |         |
| > I     |    |        |        |        |        |   |     |         |
| ndirect |    |        |        |        |        |   |     |         |
| > Cost  |    |        |        |        |        |   |     |         |
| > Rate  |    |        |        |        |        |   |     |         |
| > Agr   |    |        |        |        |        |   |     |         |
| eement: |    |        |        |        |        |   |     |         |
| > From: |    |        |        |        |        |   |     |         |
| > \_\_\ |    |        |        |        |        |   |     |         |
| _/\_\_\ |    |        |        |        |        |   |     |         |
| _/\_\_\ |    |        |        |        |        |   |     |         |
| _\_\_\_ |    |        |        |        |        |   |     |         |
| > To:   |    |        |        |        |        |   |     |         |
| > \_\_\ |    |        |        |        |        |   |     |         |
| _/\_\_\ |    |        |        |        |        |   |     |         |
| _/\_\_\ |    |        |        |        |        |   |     |         |
| _\_\_\_ |    |        |        |        |        |   |     |         |
| > (mm/d |    |        |        |        |        |   |     |         |
| d/yyyy) |    |        |        |        |        |   |     |         |
| >       |    |        |        |        |        |   |     |         |
| > Ap    |    |        |        |        |        |   |     |         |
| proving |    |        |        |        |        |   |     |         |
| >       |    |        |        |        |        |   |     |         |
| Federal |    |        |        |        |        |   |     |         |
| >       |    |        |        |        |        |   |     |         |
| agency: |    |        |        |        |        |   |     |         |
| > \     |    |        |        |        |        |   |     |         |
| _\_\_\_ |    |        |        |        |        |   |     |         |
| > ED    |    |        |        |        |        |   |     |         |
| > \     |    |        |        |        |        |   |     |         |
| _\_\_\_ |    |        |        |        |        |   |     |         |
| > Other |    |        |        |        |        |   |     |         |
| >       |    |        |        |        |        |   |     |         |
| (please |    |        |        |        |        |   |     |         |
| > sp    |    |        |        |        |        |   |     |         |
| ecify): |    |        |        |        |        |   |     |         |
| > \_\   |    |        |        |        |        |   |     |         |
| _\_\_\_ |    |        |        |        |        |   |     |         |
| \_\_\_\ |    |        |        |        |        |   |     |         |
| _\_\_\_ |    |        |        |        |        |   |     |         |
| \_\_\_\ |    |        |        |        |        |   |     |         |
| _\_\_\_ |    |        |        |        |        |   |     |         |
| \_\_\_\ |    |        |        |        |        |   |     |         |
| _\_\_\_ |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
| (3) For |    |        |        |        |        |   |     |         |
|     Res |    |        |        |        |        |   |     |         |
| tricted |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
|    Rate |    |        |        |        |        |   |     |         |
|     P   |    |        |        |        |        |   |     |         |
| rograms |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
|  (check |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
|    one) |    |        |        |        |        |   |     |         |
|     \-- |    |        |        |        |        |   |     |         |
|     Are |    |        |        |        |        |   |     |         |
|     you |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
|   using |    |        |        |        |        |   |     |         |
|     a   |    |        |        |        |        |   |     |         |
|     res |    |        |        |        |        |   |     |         |
| tricted |    |        |        |        |        |   |     |         |
|     i   |    |        |        |        |        |   |     |         |
| ndirect |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
|    cost |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
|    rate |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
|   that: |    |        |        |        |        |   |     |         |
|         |    |        |        |        |        |   |     |         |
| >       |    |        |        |        |        |   |     |         |
|  \_\_\_ |    |        |        |        |        |   |     |         |
| > Is    |    |        |        |        |        |   |     |         |
| > i     |    |        |        |        |        |   |     |         |
| ncluded |    |        |        |        |        |   |     |         |
| > in    |    |        |        |        |        |   |     |         |
| > your  |    |        |        |        |        |   |     |         |
| > a     |    |        |        |        |        |   |     |         |
| pproved |    |        |        |        |        |   |     |         |
| > I     |    |        |        |        |        |   |     |         |
| ndirect |    |        |        |        |        |   |     |         |
| > Cost  |    |        |        |        |        |   |     |         |
| > Rate  |    |        |        |        |        |   |     |         |
| > Agr   |    |        |        |        |        |   |     |         |
| eement? |    |        |        |        |        |   |     |         |
| > or    |    |        |        |        |        |   |     |         |
| >       |    |        |        |        |        |   |     |         |
|  \_\_\_ |    |        |        |        |        |   |     |         |
| > C     |    |        |        |        |        |   |     |         |
| omplies |    |        |        |        |        |   |     |         |
| > with  |    |        |        |        |        |   |     |         |
| > 34    |    |        |        |        |        |   |     |         |
| > CFR   |    |        |        |        |        |   |     |         |
| >       |    |        |        |        |        |   |     |         |
|  76.564 |    |        |        |        |        |   |     |         |
| (c)(2)? |    |        |        |        |        |   |     |         |
+---------+----+--------+--------+--------+--------+---+-----+---------+

> ED 524

+---------+---------+--------+---------+---------+---------+----------+
| > Name  |         |        | App     |         |         |          |
| > of    |         |        | licants |         |         |          |
| > Ins   |         |        | req     |         |         |          |
| titutio |         |        | uesting |         |         |          |
| n/Organ |         |        | funding |         |         |          |
| ization |         |        | for     |         |         |          |
|         |         |        | only    |         |         |          |
|         |         |        | one     |         |         |          |
|         |         |        | year    |         |         |          |
|         |         |        | should  |         |         |          |
|         |         |        | c       |         |         |          |
|         |         |        | omplete |         |         |          |
|         |         |        | the     |         |         |          |
|         |         |        | column  |         |         |          |
|         |         |        | under\  |         |         |          |
|         |         |        | \"      |         |         |          |
|         |         |        | Project |         |         |          |
|         |         |        | Year    |         |         |          |
|         |         |        | 1.\"    |         |         |          |
|         |         |        | App     |         |         |          |
|         |         |        | licants |         |         |          |
|         |         |        | req     |         |         |          |
|         |         |        | uesting |         |         |          |
|         |         |        | funding |         |         |          |
|         |         |        | for     |         |         |          |
|         |         |        | mul     |         |         |          |
|         |         |        | ti-year |         |         |          |
|         |         |        | grants  |         |         |          |
|         |         |        | should  |         |         |          |
|         |         |        | c       |         |         |          |
|         |         |        | omplete |         |         |          |
|         |         |        | all     |         |         |          |
|         |         |        | app     |         |         |          |
|         |         |        | licable |         |         |          |
|         |         |        | c       |         |         |          |
|         |         |        | olumns. |         |         |          |
|         |         |        | Please  |         |         |          |
|         |         |        | read    |         |         |          |
|         |         |        | all     |         |         |          |
|         |         |        | instr   |         |         |          |
|         |         |        | uctions |         |         |          |
|         |         |        | before  |         |         |          |
|         |         |        | com     |         |         |          |
|         |         |        | pleting |         |         |          |
|         |         |        | form.   |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+
| **      |         |        |         |         |         |          |
| SECTION |         |        |         |         |         |          |
| B -     |         |        |         |         |         |          |
| BUDGET  |         |        |         |         |         |          |
| SU      |         |        |         |         |         |          |
| MMARY** |         |        |         |         |         |          |
|         |         |        |         |         |         |          |
| **NON-  |         |        |         |         |         |          |
| FEDERAL |         |        |         |         |         |          |
| FUNDS** |         |        |         |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+
| Budget  | Project | P      | Project | Project | Project | Total    |
| Cat     | Year 1  | roject | Year 3  | Year 4  | Year 5  |          |
| egories |         | Year 2 |         |         |         | \(f\)    |
|         | \(a\)   |        | \(c\)   | \(d\)   | \(e\)   |          |
|         |         | \(b\)  |         |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+
|         |         |        |         |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+
| 1\.     |         |        |         |         |         |          |
| Pe      |         |        |         |         |         |          |
| rsonnel |         |        |         |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+
| 2\.     |         |        |         |         |         |          |
| Fringe  |         |        |         |         |         |          |
| B       |         |        |         |         |         |          |
| enefits |         |        |         |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+
| 3\.     |         |        |         |         |         |          |
| Travel  |         |        |         |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+
| 4\.     |         |        |         |         |         |          |
| Eq      |         |        |         |         |         |          |
| uipment |         |        |         |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+
| 5\.     |         |        |         |         |         |          |
| S       |         |        |         |         |         |          |
| upplies |         |        |         |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+
| 6\.     |         |        |         |         |         |          |
| Cont    |         |        |         |         |         |          |
| ractual |         |        |         |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+
| 7\.     |         |        |         |         |         |          |
| Const   |         |        |         |         |         |          |
| ruction |         |        |         |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+
| 8\.     |         |        |         |         |         |          |
| Other   |         |        |         |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+
| 9\.     |         |        |         |         |         |          |
| Total   |         |        |         |         |         |          |
| Direct  |         |        |         |         |         |          |
| Costs   |         |        |         |         |         |          |
|         |         |        |         |         |         |          |
| (Lines  |         |        |         |         |         |          |
| 1-8)    |         |        |         |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+
| 10\.    |         |        |         |         |         |          |
| I       |         |        |         |         |         |          |
| ndirect |         |        |         |         |         |          |
| Costs   |         |        |         |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+
| 11\.    |         |        |         |         |         |          |
| T       |         |        |         |         |         |          |
| raining |         |        |         |         |         |          |
| S       |         |        |         |         |         |          |
| tipends |         |        |         |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+
| 12\.    |         |        |         |         |         |          |
| Total   |         |        |         |         |         |          |
| Costs   |         |        |         |         |         |          |
|         |         |        |         |         |         |          |
| (Lines  |         |        |         |         |         |          |
| 9-11)   |         |        |         |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+
| **      |         |        |         |         |         |          |
| SECTION |         |        |         |         |         |          |
| C --    |         |        |         |         |         |          |
| BUDGET  |         |        |         |         |         |          |
| NARR    |         |        |         |         |         |          |
| ATIVE** |         |        |         |         |         |          |
| (see    |         |        |         |         |         |          |
| instru  |         |        |         |         |         |          |
| ctions) |         |        |         |         |         |          |
+---------+---------+--------+---------+---------+---------+----------+

> ED 524

# CERTIFICATION REGARDING LOBBYING

Certification for Contracts, Grants, Loans and Cooperative Agreements.

The undersigned certifies, to the best of his or her knowledge and
belief, that:

\(1\) No Federal appropriated funds have been paid or will be paid, by
or on behalf of the undersigned, to any person for influencing or
attempting to influence an officer or employee of any agency, a Member
of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with the awarding of any Federal
contract, the making of any Federal grant, the making of any Federal
Loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal
contract, grant, loan or cooperative agreement.

\(2\) If any funds other Federal appropriated funds have been paid or
will be paid to any person for influencing or attempting to influence an
officer or employee of any agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, loam or cooperative
agreement, the undersigned shall complete and submit Standard Form --
LLL, "Disclosure of Lobbying Activities," in accordance with its
instructions.

\(3\) The undersigned shall require that the language of this
certification be included in the award documents for all subawards at
all tiers (including subcontracts, subgrants and contracts under grants,
loans, and cooperative agreements) and that all subrecipients shall
certify and disclose accordingly. This certification is a material
representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification
is a prerequisite for making or entering into this transaction imposed
by section 1352, title 31, U.S. Code. Any person who fails to file the
required certification shall be subject to a civil penalty of not less
than \$10,000 and not more than \$100,000 for each such failure.

Statement for Loan Guarantees and Loan Insurance.

The undersigned states, to the best of his or her knowledge and belief,
that:

If any funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee or any
agency, a member of Congress, an officer or employee of Congress or an
employee of a Member of Congress in connection with this commitment
providing for the United States to insure or guarantee a loan, the
undersigned shall complete and submit Standard Form-LLL, "Disclosure of
Lobbying Activities," in accordance with its instructions. Submission of
this statement is a prerequisite for making or entering into this
transaction imposed by section 1352, title 31, U.S. Code. Any person who
fails to file the required statement shall be subject to a civil penalty
of not less than \$10,000 and not more than \$100,000 for each such
failure.

  -----------------------------------------------------------------------
  Applicant's Organization

  Printed Name of Authorized Representative Printed Title of Authorized
  Representative

  Signature Date
  -----------------------------------------------------------------------

ED 80-0013 08/05

**OMB Approval No. 0348-0040**

**ASSURANCES - NON-CONSTRUCTION PROGRAMS**

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

**PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT
AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.**

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

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

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

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

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

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

5\. Will comply with the Intergovernmental Personnel Act of 1970 (42
U.S.C. 4728-4763) relating to prescribed standards for merit systems for
programs funded under one of the 19 statutes or regulations specified in
Appendix A of OPM\'s Standards for a Merit System of Personnel
Administration (5 C.F.R. 900, Subpart F).

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

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

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

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

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

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

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

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

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

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

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

17\. Will cause to be performed the required financial and compliance
audits in accordance with the Single Audit Act Amendments of 1996 and
OMB Circular No. A-133, Audits of States, Local Governments, and
Non-Profit Organizations.

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

**Applicant's (Organization) Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Applicant's DUNS Number:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Grant Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_CFDA
Number: \_\_\_\_\_\_\_\_\_\_\_\_**

1\. Does the applicant have 501(c)(3) status?

Yes No

2\. How many full-time equivalent employees does the applicant have?
*(Check only one box).*

> 3 or Fewer 15-50
>
> 4-5 51-100
>
> 6-14 over 100

3\. What is the size of the applicant's annual budget? *(Check only one
box.)*

Less Than \$150,000

\$150,000 - \$299,999

\$300,000 - \$499,999

\$500,000 - \$999,999

\$1,000,000 - \$4,999,999

\$5,000,000 or more

4\. Is the applicant a faith-based/religious\
organization?

Yes No

5\. Is the applicant a non-religious community-based organization?

Yes No

6\. Is the applicant an intermediary that will manage the grant on
behalf of other organizations?

> Yes No

7\. Has the applicant ever received a government grant or contract
(Federal, State, or local )?

Yes No

8\. Is the applicant a local affiliate of a national\
organization?

Yes No

# Survey Instructions on Ensuring Equal Opportunity for Applicants

# 

**Provide the applicant's (organization) name and DUNS number and the
grant name and CFDA number.**

1\. 501(c)(3) status is a legal designation provided on application to
the Internal Revenue Service by eligible organizations. Some grant
programs may require nonprofit applicants to have 501(c)(3) status.
Other grant programs do not.

2\. For example, two part-time employees who each work half-time equal
one full-time equivalent employee. If the applicant is a local affiliate
of a national organization, the responses to survey questions 2 and 3
should reflect the staff and budget size of the local affiliate.

3\. Annual budget means the amount of money your organization spends
each year on all of its activities.

4\. Self-identify.

5\. An organization is considered a community-based organization if its
headquarters/service location shares the same zip code as the clients
you serve.

6\. An "intermediary" is an organization that enables a group of small
organizations to receive and manage government funds by administering
the grant on their behalf.

7.  Self-explanatory.

8.  Self-explanatory.

**\
**

**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 1890-0014. The time required
to complete this information collection is estimated to average five (5)
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.
2202-4651.

**If you have comments or concerns regarding the status of your
individual submission of this form, write directly to:** Joyce I. Mays,
Application Control Center, U.S. Department of Education, 7^th^ and D
Streets, SW, ROB-3, Room 3671, Washington, D.C. 20202-4725

> OMB No. 1890-0014 Exp. 1/31/2006

SF 424 Supplement

Approved by OMB

0348-0046

**Disclosure of Lobbying Activities**

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

(See reverse for public burden disclosure)

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

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

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

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

**Instructions for Certification**

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

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

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

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

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

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

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

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

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