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U.S. DEPARTMENT OF EDUCATION, 

OFFICE OF POSTSECONDARY EDUCATION

FINANCIAL REPORT FORM UNDER THE 

ENDOWMENT CHALLENGE GRANTS PROGRAM (Title III, Part C)

AND ENDOWMENT ACTIVITIES UNDER THE

TITLE III PARTS A & B AND TITLE V PROGRAMS

NOTE TO ENDOWMENT CHALLENGE GRANT RECIPIENTS ONLY. If you 

received your initial ECG award prior to 1987, your grant number will begin with GOO. 

After 1987, your grant number will begin with P031G. If your institution has been 

awarded more than one Endowment Challenge Grant (ECG), you must report on each 

grant separately, by completing this form using the respective project award and/or grant 

numbers. 

NOTE TO TITLE III AND TITLE V GRANTEES THAT HAVE ENDOWMENT 

AS AN ACTIVITY: The Endowment Fund Corpus amount may change from year to 

year if you elected to use Federal funds for endowment building more than one year of 

your five year grant period and added to the original corpus rather than creating a 

different account for each drawdown. For example, if in year one you raised and 

matched $50,000 of Federal funds, and you invested $100,000 to form the endowment 

corpus, then in year two you elected to raise and match $25,000 of Federal funds for a 

total of $50,000 and decided to add this $50,000 to the original $100,000, your corpus 

then changes from $100,000 to $150,000. However, if you have chosen to develop a 

separate endowment corpus for each year, you must report on each individual investment

separately, by completing this form for each. 

NAME OF INSTITUTION:_________________________________________________

ADDRESS :_________________________________________________

CITY AND STATE :_________________________ ZIP CODE:_____________

GRANT NUMBER :_________________________________________________

CONTACT PERSON :_________________________________________________

E-MAIL :_________________________________________________

TELEPHONE NUMBER :_________________________________________________

FAX :_________________________________________________
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1. Enter the initial fiscal year (FY) this grant was awarded: FY______

2. Enter the amount of the institution’s original Endowment Fund Corpus: $_______

3. In which fiscal year did the institution submit the “initial” financial report: FY_____

4. Enter your institution’s fiscal year or budget period covered by this report:

From ____________________ to ____________________

 Month/Day/Year Month/Day/Year

5. This is report number _____ of 20

INVESTMENT DISTRIBUTIONS - FOR CORPUS ONLY

Reference: Section 628.43 of the program regulations

 

 TYPE OF SAVINGS Amount Name of 

ACCOUNT OR SECURITY Financial Institution 

(a) A federally insured 

bank savings account: $____________ _______________________

(b) A compatible interest 

bearing account: $____________ _______________________

(c) A money market fund: $____________ _______________________

(d) Certificates of deposit: $____________ _______________________

(e) Mutual funds: $____________ _______________________

(f) Stocks: $____________ _______________________

(g) Bonds: $____________ _______________________

(h) Other (please specify type of investment account): 

_____________________ $____________ ________________________

_____________________ $____________ ________________________

_____________________ $____________ ________________________ 
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TOTAL INVESTED (a-h): $____________

INCOME EARNED

Enter the amount of the endowment fund income earned during the 12- 

month period covered by this financial report. $______________

Enter the cumulative (aggregate) amount (to date) of all endowment fund income earned 

since the initial investment. $______________

INCOME USED

Enter in the appropriate space(s) below, the amount of endowment fund income used, 

both for the 12-month period covered by this report, and the aggregate, for the 

following purposes:

 CURRENT AGGREGATE

a) Operations and maintenance: $______________ $_____________

b) Administration and management

 of the endowment fund : $______________ $_____________

c) Buying and selling securities: $______________ $_____________

d) Academic and support personnel: $______________ $_____________

e) Construction and renovation: $______________ $_____________

f) Community and student services

 programs and technical assistance: $______________ $_____________

g) Other (Please specify below):

___________________________ $______________ $_____________

___________________________ $______________ $_____________

 

 TOTAL (a-g): $______________ $_____________
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CERTIFICATION

I certify that:

-No part of the endowment fund corpus has been invested in real estate (Section 

628.43 of the regulations);

-No part of the endowment fund corpus has been withdrawn and/or expended 

(Section 628.44 of the regulations);

-Not more than fifty percent of aggregate endowment fund income has been 

withdrawn and/or expended (Section 628.45 of the regulations).

President (or Certified Official):

_________________________________ ______________________

 (Signature) (Date)

 (Name - Type or Print)

 (Title -Type or Print)

 (E-mail – Type or Print) (Phone Number)

WARNING: Any person who knowingly makes a false statement or misrepresentation 

on this form is subject to penalties which may include fines and/or imprisonment under 

the United States Criminal Code. 

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 1840-0564. 

The time required to complete this information collection is estimated to average 3 hours 

per response, including the time to review instructions, search existing data resources, 

gather the data needed, and complete and review the information collection. 

If you have any comments concerning the accuracy of the time estimate(s) or 

suggestions for improving this form, please write to: U.S. Department of Education, 

Washington, D.C. 20202-4651. If you have comments or concerns regarding the 

status of your individual submission of this form, write directly to: U.S. Department 

of Education, Office of Postsecondary Education, Institutional Development and 

Undergraduate Education Service. Attention: Karen W. Johnson, 1990 K Street, NW, 

6

th Floor, Washington, D.C. 20006.
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This financial reporting form will be utilized for Title III, Part A, Title III Part B, Title V 

Program Endowment Activities, and Title III Part C Endowment Challenge Grant 

Programs. The purpose of this Annual Financial Report is to have the grantees report 

annually the kind of investments that have been made, the income earned and spent, and 

whether any part of the Endowment Fund Corpus has been spent. This information allows 

us to give technical assistance and determine whether the grantee has compiled with the 

statutory and regulatory investment requirements. Responses to the collection of 

information are required consistent with the provisions of P.L. 98-95 Section 331 under 

the Endowment Challenge Grant, HEA 1965, as amended. As these materials contain no 

confidential information, these application materials will become part of ED’s public 

records once submitted and approved in accordance with the regulations promulgated 

under the Paperwork Reduction Act (5 CFR 1320.8(b)(3)(v)).