# GEAR UP PROGRAM-SPECIFIC FORMS

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applicant eligibility form

local education agency

Partnership applications must be submitted by an eligible entity: a Local Education Agency (LEA) or an Institution of Higher Education (IHE). This form is required to verify if the entity applying for funding is legally an LEA.

If applying as an LEA, please provide your organization’s National Center for Education Statistics (NCES) ID for school districts below. Your NCES ID can be found at: https://nces.ed.gov/ccd/districtsearch/index.asp.**The name of the LEA listed on the NCES webpage must match your applicant name on the SF-424 form.**

However, if your organization is not listed on the NCES webpage, or is listed differently, please have the Chief State School Officer (CSSO) sign below to certify your identity as an LEA. **You can locate the CSSO in your state by going to**https://ccsso.org.

applicant eligibility form

institution of higher education

Partnership applications must be submitted by an eligible entity: a Local Education Agency (LEA) or an Institution of Higher Education (IHE). This form is required to verify if the entity applying for funding is legally an IHE.

Please provide your organization’s National Center for Education Statistics (NCES) Office of Postsecondary Education (OPE) ID for your college or university below. The OPE ID number is assigned by the U.S. Department of Education (Department) to identify schools that have Program Participation Agreements so that their students are eligible to participate in Federal Student Financial Assistance programs under Title IV regulations. While your institution is not required to have an OPE ID, it allows the Department to easily verify your eligibility. Your NCES OPE ID can be found at: https://nces.ed.gov/collegenavigator.**The name of the IHE listed on the NCES webpage must match your applicant name on the SF-424 form.**

However, if your organization does not have an OPE ID on the NCES webpage, please have the president or provost of your college or university sign below to certify your identity as an IHE.

PARTNERSHIP PROJECT PROFILE SHEET

Institution/Agency (Legal Name): 

1. Applicant Eligibility. Only an institution of higher education (IHE) or local education agency (LEA) can apply for a GEAR UP grant and serve as fiscal agent. Have you included the Applicant Eligibility Form in your application? _YesNo

2. Partnership. An eligible partnership must consist of (i) one or more local educational agencies; and (ii) one or more degree-granting institutions of higher education; and MAY include

(i) not less than two other community organizations, such as businesses, professional organizations, state agencies, institutions, etc.

a. Did you submit your application in the Grants.gov system under the Partnership Assistance Listing #84.334A?YesNo

**Note: Please be careful not to submit your Partnership application in Grants.gov under the wrong Assistance Listing #84.334S.**

b. In the table below, please list the name of the organization for each partner (**including the applicant organization**), the organizational code using the key below, the total amount each partner will contribute over the six- or seven-year performance period, and a brief description of the contribution.

**This table can be expanded, if needed.**

**Organizational Code**

**CBO**=Community-Based Organization; **NPO**=Not-For-Profit Organization, non-CBO; **FBO**=Faith-based Organization; **HBCU**=Historically Black College or University; **TCCU**=American Indian Tribally Controlled Colleges and Universities; **HSI**=Hispanic Serving Institution; **IHE**=Institution of Higher Education; **SCH**=School; **LEA**=School District; **ACY**=State Agency; **BUS**=Business; **PO**=Professional Organization; **O**=Other Type of Organization

**Notes: 1) You can use more than one organizational code, if applicable (e.g., IHE/HSI); and 2) Only listing schools in the table above in lieu of an LEA will not satisfy the partner eligibility requirement (at least one LEA and at least one IHE).**

3. Competitive Preference Priorities (CPP) 

There are three CPPs for the Partnership competition. An applicant may be eligible to receive up to 5 additional points for addressing CPP 1, up to 5 additional points for addressing CPP 2, and 3 points for addressing CPP 3. For more details, please refer to the *Federal Register*Notice Inviting Applications.

Please mark with an (x) below whether or not this application addresses each priority.

	a.  **CPP 1**.- Under CPP 1, an applicant may be eligible to receive up to 5 additional points related to increasing postsecondary education access, affordability, completion, and post-enrollment success for underserved students by establishing a system of high-quality data collection and analysis.  For more details, please refer to the *Federal Register* Notice Inviting Applications.  

		Did you address CPP 1 in your application?  ____ Yes ____ No

b.  **CPP 2** - Under CPP 2, an applicant may be eligible to receive up to 5 additional points related to meeting student social, emotional, and academic needs. For more details, please refer to the *Federal Register* Notice Inviting Applications.

		Did you address CPP 2 in your application? ____ Yes ____ No

c. **CPP 3** – Under CPP 3, an applicant may be eligible to receive 3 additional points if their application is supported by evidence that meets the definition of ‘moderate evidence’. For more details, please refer to the *Federal Register* Notice Inviting Applications. 

i. Did you address CPP 3 in your application? ____ Yes ____ No

ii. Did you fill out the Evidence Form (OMB 1894-0001) located in the forms section of the application package? ____ Yes ____ No 

4. Cohort Model. Please answer the following questions regarding the cohort model:

a. Entire Grade Level. Are you planning to serve at least one entire grade level of students in the target school(s) as your cohort?Yes _No

b. Continued Services. Are you planning to provide services to participating GEAR UP students **beginning no later than 7th grade**through the 12th grade?YesNo

c. First Year of College. Are you planning to provide services to GEAR UP students through their first year of attendance at an institution of higher education?

 YesNo

**Note: When selecting the starting grade level, please keep in mind that you must continue to provide services to students until they graduate from secondary school or until their first year of college, depending on the six- or seven-year performance period. Such services must be rendered to students who are left in the pipeline after Federal funds have been discontinued.**

d. Target School Eligibility. Please provide information on the originating target schools in the table below. The originating school is the school or schools in which your GEAR UP project will start implementing services. Applicants with more than one school district must fill out a chart for each district. **Important note: All originating target schools must be presented in your application.**

**School District:**

**Note: 1) You can find the NCES ID for your school(s) by going to****https://nces.ed.gov/ccd/schoolsearch.****2) All originating target schools should be presented in your application. School eligibility is determined based on the information provided in the application. If an application is approved for funding, school changes may be approved based on special or extenuating circumstances.**

If your State/school district does not collect free and reduced-price lunch data for the originating target school(s), please **describe**below what method is used (e.g., percentage for Community Eligibility Provision) to determine high-poverty schools.

**This table can be expanded, if needed.**

e. Students to be Served - In the table below, please indicate the number of students your project intends to serve in each grade level per year of the six- or seven-year grant performance period.

Note: Applicants should not include any proposed students in the shaded area, unless your project is serving students from a previous GEAR UP grant. Please provide the PR Award number for the previous grant: P334A.

**Note: Projects can only serve students in the 7th year who are in high school or in their first year of postsecondary education.**

f. Public-Housing Focus. Please list below the name of the public-housing complex(es) or area(s) that you are planning to serve.

**This table can be expanded, if necessary.**

5. Required Services – Please provide a brief outline in the table below of proposed outreach and supportive services that will be implemented to accomplish the activities that are required by statute. **Note: All objectives and services should be presented in the Project Narrative section of your application, under the Quality of Project Design selection criterion.**

****

6. Project Budget

Federal Funds Requested. The maximum amount a Partnership applicant can receive per student for a single budget period of 12 months is $800. Please fill out the table below, which calculates the maximum amount you can request per year for the six- or seven-year performance  period.

a. Did you allocate more than $800 of Federal funds per student (each year) on the **Project   Budget Summary Form**?YesNo

b. Required Match - The non-Federal cost provided by a project must be no less than 50 percent of the total cost of the project at the end of the six- or seven-year project period. Is the total amount of matching contributions equal to or greater than the total amount of Federal funds requested for the six- or seven-year project period in the Project Budget Summary Form?

 YesNo

**Note: The matching requirement is 50 percent of the entire project, combining federal and non-federal funds, not 50 percent of what is requested in Federal funds. For instance, if an applicant requests a six- or seven-year total of $3 million in Federal funds, the matching contribution required is not $1.5 million. The required matching contribution is $3 million.**

c. A Partnership applying for a GEAR UP grant can request to waive a portion of the matching  requirement. If you are requesting a waiver, please check below the type of waiver you are requesting. Details regarding the matching waiver provisions can be found in the Program Overview section of this application package.

· request to waive up to 50 percent;

· request to waive up to 70 percent;

· request to waive up to 75 percent; or

· request to satisfy matching requirement based on the scholarship funds.

i. Please provide a detailed explanation below to support the waiver reduction request according to the provision that was selected above.

**This table can be expanded, as needed.**

**Note: If your application is successful in this competition, we will assess whether you are eligible for a matching waiver based on the information provided in Question 6(c)(i). You will receive a determination notification regarding your request after the grant is awarded.**

ii. Please present in the chart below the proposed amount of matching contributions that will be provided each year of the project, ***if your matching waiver request is approved.***

d. Please provide below the amount of Federal funds that you are requesting and the requiredmatching contribution for each year of the project period. ***Do not include a reduced matching  contribution in this table.***

**Note: 1) A project cannot request more Federal funds in subsequent project years than the total amount requested in the first year. 2) The total matching contributions must be at least equal to the total Federal funds requested for the six or seven years of the grant.**

e. Indirect Cost Rate. GEAR UP projects a) can only charge indirect costs to the grant if the organization/agency has an approved indirect cost rate agreement; and b) the maximum amount of indirect costs must be no more than 8 percent of modified direct costs (direct costs excluding scholarships and equipment). **Note: This requirement applies to Federal and matching funds.**

If you are requesting reimbursement for indirect costs, please answer the following questions:

i. Do you have an Indirect Cost Rate Agreement approved by the Federal government?

YesNo

ii. If yes, please provide the following information: Period Covered by the Indirect Cost Rate Agreement:

From://To://(mm/dd/yyyy)

Approving Federal agency:ED	 Other (please specify): _

iii. Are you using a restricted indirect cost rate that:Is included in your approved Indirect Cost Rate Agreement? orComplies with 34 CFR 76.564(c)(2)?

PROJECT BUDGET SUMMARY FORM

This form presents the amount of Federal funding requested and non-Federal contributions for the entire six- or seven-year project performance period. **Applicants must fill out and submit both sections (Federal and non-Federal) of the form.**

**Important Note: Please do not include a requested amount of Federal funds in years two through six or seven that is more than the amount that is requested in Year 1.**

Project Budget Summary Form (continued)

* T**he total proposed matching contributions in Part II of the Budget Summary Form for the six- or seven- year performance period should be at least equal to the proposed total requested Federal funds in Part I of the Budget Summary Form. For example, if the total cost to run the project for the six- or seven-year performance period is $300, the Federal contribution would be $150 and the required matching contribution must be at least $150.**

###### Matching Waiver Request – Partnership applicants can request to waive the required match based on certain statutory and regulatory provisions:

1. Have you filled out Question 6c of the Project Profile Sheet?YesNo

2. Please check below the type of waiver provision that you are requesting. Please see the

*Program Overview*section of the application package for descriptions of waiver provisions.

 50 percent;70 percent;75 percent;scholarship

3. Indicate in the table below the yearly amount of proposed matching contributions that will be provided if you receive a waiver. This table should be consistent with Question 6(c)(ii) of the Project Profile Sheet.

APPLICANT ORGANIZATION IDENTIFICATION

FORM AND COST SHARE WORKSHEET

###### Please provide the following information for the Applicant Organization and its share of matching commitments (cash or in-kind) for each year of the proposed project. Please note this form does not represent the required match for the entire project – it only addresses theamount of matching contributions the applicant will provide.

**1. Type of Institution/Organization**

Are you a State Education Agency (SEA)?

YesNo

Are you an Institution of Higher Education (IHE)?

YesNo

Type of IHE:

Four-YearTwo-Year

Public	 Private

 College	 University

HBCU	HSI_TCCUNHSIANSI

1. Salaries and Wages

2. Employee Benefits

3. Travel

4. Materials and Supplies

5. Consultants and Contracts

6. Other

A. **Total Direct Costs**

*(Sum of lines 1-6)*

B. **Total Indirect Costs:**

*(Cannot be greater than 8% of Total Direct Costs)*

C. **Equipment**

D. **Scholarships/ Tuition Assistance**

E. **TOTAL**

**COMMITMENT**

(Lines A+B+C+D)

PARTNER IDENTIFICATION FORM AND COST SHARE WORKSHEET

**Please complete one form for each partner (other than the Applicant Organization).**

1. **Institution/Organization*Point of Contact***: Name TitleDepartment Address

City 

State

Zip_

Telephone 

2. **Type of Organization**

e-mailFax 

Are you a Local Educational Agency (LEA)?

 YesNo

Are you an Institution of Higher Education (IHE)?

 YesNo

Type of IHE:

Four-YearTwo-Year

Other types:

Business

Community-based organization

Professional association

Philanthropic Organization

State Agency

Public

Private

Other: 

College	University

HBCUHSITCCUNHSIANSI
**3. Non-Federal Fund contribution provided by Partner**

**YEAR 1	YEAR 2	YEAR 3	YEAR 4	YEAR 5	YEAR 6	YEAR 7	TOTAL**

PR Award No.

SIGNATURE OF AUTHORIZING OFFICIAL:  NAME OF AUTHORIZING OFFICIAL: TITLE OF AUTHORIZING OFFICIAL:

FIRST YEAR BUDGET NARRATIVE FORM

Please provide a written narrative for each budget line item, which explains: (1) the basis for estimating the costs of professional personnel salaries, benefits, project staff travel, materials and supplies, consultants and subcontracts, indirect costs, and any projected expenditures; (2) how the major cost items relate to the proposed activities; and (3) the costs of evaluation.

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