GEAR UP PROGRAM-SPECIFIC FORMS

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STATE APPLICANT ELIGIBILITY FORM

**Assistance Listing No. 84.334S**

This form is required to verify if the agency applying for funding under the GEAR UP State grant competition is authorized by the Governor of the State.  The Governor of a State, or equivalent for eligible non-States, must designate the State agency that can apply for, and administer, a State GEAR UP grant. 

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STATE PROJECT PROFILE SHEET

Institution/Organization (Legal Name): ___________________________________________

1.  Applicant Eligibility – The Governor of each State, or equivalent for eligible non-States, must designate one agency that can apply for and administer the GEAR UP State grant.  

a.  Did you fill out and include the Applicant Eligibility Form in the application?  

____ Yes ____ No 

b.  Did you submit your application in the Grants.gov system under the State Assistance Listing #84.334S? ____ Yes ____ No 

**Note:  Please be careful not to submit your State application under the wrong Assistance Listing #84.334A, which is only applicable to Partnership applicants.**

2.  Competitive Preference Priorities (CPP) – 

a.  **CPP 1**– Under CPP 1, an applicant may be eligible to receive up to 2 additional points.  For more details, please refer to the *Federal Register* Notice Inviting Applications.  If you are applying for CPP 1, please provide the requested information below.

i. Provide the PR/Award Number below for any successful GEAR UP State grant that your organization implemented prior to August 14, 2008.

P334S_______________

P334S_______________

ii.  Provide a brief description below of prior, demonstrated commitment to early intervention leading to college access through collaboration and replication of successful strategies.

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

**Note: Applicants addressing CPP 2, CPP 3, and CPP 4 must provide details in a separately uploaded CPP file in the Project Narrative Section of the application.**

b.  **CPP 2**.- Under CPP 2, 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 2 in your application?  ____ Yes ____ No

c.  **CPP 3** - Under CPP 3, 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 3 in your application? ____ Yes ____ No

d. **CPP 4** – Under CPP 4, 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 4 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 

3. 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  

**Note: You can use more than one organizational code, if necessary (e.g., IHE/HSI).**

4.  Implementation Model – Please check below which model you are proposing to implement.  

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· a.  Cohort Model 

· b.  Priority Students Model 

· c.   Models a and b

5.  **Priority Students Model**

a.  If you are implementing the priority students model, please indicate below the number of students you propose to serve each year.  

b.  List the grade level(s) you are planning to serve (e.g., 7th - 12th grades).  _________________

c.  List the type(s) of priority/disconnected students the project will serve (e.g., 12th graders, free and reduced-priced lunch, foster, homeless, and disabled). _____________________________ ____________________________________________________________________________

6.  **Cohort Model**

If you are implementing the cohort model, please answer the following questions:  

a. One Grade Level.  Are you planning to serve at least one 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?  ____ Yes ____ No 

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? 

 ____ Yes ____ No

**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.**

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

**Notes:   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. 

Applicants should not include any proposed students in the shaded area of the table, unless your project is serving students from a previous GEAR UP grant.   Please provide the project number for the previous grant:  P334S_________.

**Note:   Projects can only serve students in the 7th year who are in high school or in their first year of postsecondary education.   In addition, projects implementing a priority students model should not fill out the table above.**

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

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

7.  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.**

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

8.  Project Budget

a. Federal Funds Requested.  The total amount of Federal funds a State project can receive each year is $5 million.  Did you request more than $5 million each year in your Budget Summary Form? ____ Yes ____ No

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 performance period.  Are the total six- or seven-year matching contributions presented on the Budget Summary Form equal to or greater than the total six- or seven-year Federal funds requested?   ____ Yes ____ No

**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.  Please provide below the amount of Federal funds you are requesting and matching contributions for each year of the project period.

**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 should be at least equal to the total Federal funds requested for the six or seven years of the grant.**

d.  State Funding Allocation.  State funds must be allocated as follows:  no less than 25 percent and no more than 50 percent of Federal funds must be allocated for activities and all remaining funds must be allocated for scholarships to eligible GEAR UP students.  Applicants can allocate more than 50 percent for activities if they receive an exception.  Applicants for an exception must demonstrate in the application that they have another means or multiple means of providing scholarships that meet the minimum Pell Grant requirements to students eligible for a GEAR UP scholarship. 

i.  Did you allocate at least 25 percent and no more than 50 percent of Federal funds, as outlined on the Budget Summary Form, for activities?  ____ Yes ____ No 

ii.  If you are planning to use more than 50 percent of the Federal funds for activities, please briefly describe below how eligible students will receive scholarships through another means or multiple means, such as by providing a list of other sources of aid that reduce or eliminate the need for the grantee to provide scholarships from their federal funding; the projected number of students that the grantee expects to receive aid through those sources; and an estimate of the number of students eligible for a GEAR UP scholarship that are not expected to receive aid through those other sources, if any. 

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

**Note:  If you propose to provide scholarships through another means, you will have to report the number of GEAR UP students who received scholarships and the average amount disbursed.**

iii. Please indicate below the dollar amount and percentage of the Federal funds requested that will be allocated for scholarships and activities.

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.**

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

____Yes  ____ No 

ii. If yes, please provide below the period covered by the Indirect Cost Rate Agreement:  

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

Approving Federal agency:  ____ ED     ____ Other (please specify): ____________ 

iii.  For Restricted Rate Programs, are you using a restricted indirect cost rate that: ___Is included in your approved Indirect Cost Rate Agreement? or ___ Complies 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 6- or 7-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)

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#### * The 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 for Federal expenditures 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.

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.   

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

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