U.S. Department of Education

Washington, D.C. 20202-5335

APPLICATION FOR GRANTS

UNDER THE

Section 8007(b) Emergency Application for Discretionary Construction Program

CFDA # 84.041C

PR/Award # N/A

OMB No. 1810-0657, Expiration Date: 07/31/2014

Closing Date: 04/16/2013 12:00:00 AM

PR/Award # N/A
Table of Contents

Sl# Title Page#

1. Instructions for Completing an Application for Discretionary Construction Grants -------------------------------------------------- 3

2. Section 8007 (b) - Coversheet --------------------------------------------------------------------------------------------------------------------------- 3

3. Section 8007 (b) - Additional Information ------------------------------------------------------------------------------------------------------------ 4

4. Section 8007 (b) - Project Narrative for Emergency Grant Application -------------------------------------------------------------------- 5

5. Standard Project Narrative Form ----------------------------------------------------------------------------------------------------------------------- 6

6. Section 8007 (b) - Justification for Rebuilding ----------------------------------------------------------------------------------------------------- 7

7. Section 8007(b) - Cost Estimate Table ---------------------------------------------------------------------------------------------------------------- 8

8. Section 8007 (b) - Applicant's Section 8003 Application - Table 1 -------------------------------------------------------------------------- 9

9. Section 8007 (b) - Applicant's Section 8003 Application - Table 2 -------------------------------------------------------------------------- 10

10. Section 8007 (b) - Applicant's Section 8003 Application - Table 3 -------------------------------------------------------------------------- 11

11. Section 8007 (b) - Applicant's Section 8003 Application - Table 4 -------------------------------------------------------------------------- 12

12. Section 8007 (b) - Applicant's Section 8003 Application - Table 5 -------------------------------------------------------------------------- 13

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U.S. DEPARTMENT OF EDUCATION FORM APPROVED

WASHINGTON, DC 20202-6244 OMB NO. 1810-0657

EXPIRATION DATE: 07/31/2014

IMPACT AID PROGRAM

INSTRUCTIONS FOR COMPLETING APPLICATION FOR DISCRETIONARY 

CONSTRUCTION PROGRAM, SECTION 8007(b), ELEMENTARY AND SECONDARY 

EDUCATION ACT

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 1810-0657. This information collection is required to obtain benefits. The time required 

to complete this information collection is estimated to average 4.5 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 

any comments or concerns regarding the status of your individual submission of this form, 

write directly to: Impact Aid Program, U.S. Department of Education, 400 Maryland Ave., 

S.W., Washington, D.C. 20202-6244.

Please read these instructions and the application notice carefully before you complete the 

application. You should also review the authorizing statute (section 8007(b) of the Elementary 

and Secondary Education Act) and regulations (34 CFR Part 222, Subpart L), which provide 

detailed eligibility requirements, definitions of terms, and the specific requirements of various 

sections of the law. The authorizing legislation and regulations are available on the Impact Aid 

Program (IAP) Internet web site, www.ed.gov/offices/OESE/ImpactAid, or from the IAP. If you 

need further assistance in preparing this application please, call the IAP at 202-260-3858.

WHO MAY APPLY

A limited number of local educational agencies (LEAs) that are eligible for funding under the 

Impact Aid Program and that meet certain fiscal capacity and effort requirements may apply for 

assistance under the discretionary construction program. For this competition, we are accepting 

applications under Priorities One and Two. See the program regulations at 34 CFR 222.177 for 

eligibility requirements under Priority One and the regulations at 34 CFR 222.178 and 222.179

for eligibility requirements under Priority Two. Please note that the definitions of “no capacity” 

and “minimal capacity” to issue bonds are found at 34 CFR 222.176.

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HOW AND WHEN TO APPLY

The deadline for submitting this electronic application is 11:59 p.m., Washington, D.C. 

time, April 15, 2013.

You must fax the original signed copies of the application cover page to the IAP by 11:59 p.m., 

Washington, D.C. time, on the deadline date. If you were not able to upload a signed copy of the 

independent emergency certification to your application, the signed copy must also be faxed. An 

application cannot be considered timely filed and eligible for consideration for funding unless all 

of these documents are received by the application deadline.

The toll-free fax number for the Impact Aid Program is (866) 799-1272.

When an LEA submits the application to the U.S. Department of Education, it must forward a 

complete copy of the application to its state educational agency (SEA). At the same time, if its 

state participates in the Executive Order 12372 review process, it must submit a copy of the 

application to its state's designated single point of contact. See the appendix for more 

information.

COVER PAGE

Federal Debt Delinquency

Check Yes if the applicant’s organization is delinquent on any Federal debt. (This question 

refers to the applicant’s organization and not to the person who signs as the authorized 

representative. Categories of debt include delinquent audit disallowances, loans and taxes.) 

Otherwise, check No.

Applicant’s DUNS Number

Enter the LEA’s DUNS number that is used on the LEA’s section 8003 application. This 

number also may be found on any Impact Aid payment voucher the LEA has received since 

1999. 

Applicant’s Taxpayer Identification Number

Enter the LEA’s taxpayer identification number as assigned by the Internal Revenue Service.

Applicant’s Impact Aid Number

Enter the LEA’s Impact Aid Number that is used on the LEA’s section 8003 application. This 

number also may be found on any Impact Aid payment voucher the LEA has received.

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LEA Identification and Address

Make corrections to the LEA name and address information that is displayed, if necessary.

Contact Person

Enter the name, title, phone and fax numbers, and e-mail address of the appropriate person to be 

contacted at the LEA if there are questions regarding this application.

Name of School Facility

Enter the name of the school facility for which funding is requested. Applicants may submit 

only one application for one educational facility as provided by 34 CFR 222.183. If an applicant 

submits more than one application, the Department will consider only the first submission, as 

determined by the G5 e-application system.

Enrollment 

Enter the total enrollment in this school facility for school year 2011-2012 as of the survey date 

reported on the local educational agency’s fiscal year 2013 application for section 8003. 

Executive Order 12372 Review

Enter the date the LEA’s application was submitted to its state for review. If the applicant’s state 

does not participate in this review process or has not selected this program for review, enter N/A 

(for not applicable). See the appendix for additional information.

Authorized Representative Certification

Enter the name and title of the LEA’s authorized representative. The representative must sign 

and date the cover page of the application.

The IAP cannot consider an application for funding unless it is complete and timely filed. This 

means that the forms must be submitted electronically and the signature pages must be faxed by 

the application deadline.

ADDITIONAL INFORMATION

Interest in School Facility

Check Own, Lease or Other. If you check Lease, enter the expiration date of the lease. If you 

check Other, provide additional information describing the arrangement for use of the building.

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Type of Special District

If the applicant is a charter school, Alaskan Rural Education Attendance Area, or coterminous 

district, please check the appropriate box.

Age of School Facility

Enter the year the facility was built. If this building has had major renovations or additions since 

the original construction, enter the year and describe the nature of the renovation (e.g., 

replacement of roof, replacement of heating, ventilation and air conditioning system, 

construction of additional classrooms).

Acreage in LEA

Enter the total acres of land within the boundaries of the LEA. Enter the total acres of 

nontaxable Federal property within the boundaries of the LEA. Applicants may include Federal 

property that is not eligible for payments under section 8002 in the second figure.

Bonded Indebtedness

Enter the maximum bonding capacity of the LEA. Enter the amount of bonded debt owed by the 

LEA. Both these amounts must be as of the end of the LEA’s 2011-2012 school year. 

Assessed Value

For each taxing jurisdiction within the LEA, enter the total assessed value of the real property 

(land and improvements) in the LEA that was taxed for school purposes for school year 2011-

2012. Most LEAs have a single taxing jurisdiction and may use just one line on this form to 

enter their data. Some LEAs contain multiple jurisdictions such as townships or are located in 

more than one jurisdiction such as two counties and must use multiple lines on this form.

PROJECT NARRATIVE FOR EMERGENCY GRANT APPLICATION

Give the proposed start and end dates for the project.

Prepare a complete but succinct description of the proposed project that includes the following 

information:

 A detailed description of the nature and scope of the emergency condition

 Which mechanical systems are impacted

 How much of the building is involved

 The importance of the affected area to the instructional program

 The population affected (students, teachers, administrators, etc.)

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 The proportion of the building occupants affected by the condition. 

Describe how the emergency condition adversely affects the health, safety and well-being of the 

occupants of the school facility.

Describe any actions the applicant has taken to respond to the emergency condition, and why the 

applicant has been unable to resolve the condition.

Describe how the proposed project will address the emergency condition, and indicate the 

potential effects of delaying the project, including increased future costs.

Describe the proposed project in as much detail as possible. Include a timeline of major 

activities such as design, contract solicitation and award, and construction begin and end dates. 

Report other resources available to the LEA that can be used for this project. Include anticipated 

receipts such as state construction grants, which the LEA has not actually yet received. This 

information, along with information contained in the LEA’s annual financial reports, will be 

used to evaluate the amount of grant funding in accordance with 34 CFR 222.191(b).

Most applicants find 2-3 pages sufficient for the project narrative. Do not include supplemental 

drawings, photographs, or other extraneous materials relating to the proposed project as the 

reviewers will not consider them. 

INDEPENDENT CERTIFICATION FOR EMERGENCY GRANT APPLICATION

Enter the name, title and organization of the certifying local official. An application for an 

emergency grant must include a signed statement from an appropriate certifying official 

certifying that the deficiency described in the narrative for the proposed project threatens the 

health or safety of the occupants or prevents the use of all or a portion of the building. The 

certifying official must either use the form provided or submit a statement on official letterhead. 

Appropriate certifying officials may include individuals such as fire marshals, state building 

inspectors, local zoning officials, military installation officials, Indian Health Services officials, 

or other individuals who are responsible for inspecting school facilities and identifying health 

and safety deficiencies. Certifying officials may not be a staff member of the applicant LEA.

The signed certification must either be uploaded to the application in PDF format or be faxed to 

the IAP on or before the application deadline. If the signed certification is not received by the 

application deadline, the application will not be eligible for funding. 

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JUSTIFICATION FOR REBUILDING

An applicant that believes that rebuilding would be less expensive or more cost effective than 

repairing or renovating the existing facility must provide a detailed justification, including cost 

estimates for both alternatives. The applicant may propose rebuilding only if the LEA holds 

title to the existing facility for which funding is requested. Most applicants find 1-2 pages 

sufficient for this justification. Do not include drawings, designs, or other extraneous documents

regarding proposed projects because reviewers will not consider them.

COST ESTIMATE TABLE

The data entered on this table should be based on actual estimates. The estimates should take into 

consideration the delay between the application for funds and actual construction. 

For each line item, in column 1, provide the amount that the school district is able to contribute 

to the line item from state or local funds. In column 2, indicate the amount of grant funds 

requested. The form will automatically total column 1 and column 2 to indicate the total cost 

estimate for that line item.

On line (a), provide an estimate of the direct costs associated with this project. While there are 

no indirect costs allowed for these projects, a district may be reimbursed for direct costs that are 

necessary and reasonable to the grant. Examples of acceptable direct costs are supplies, 

equipment, advertising, and travel. 

On line (b) provide an estimate for the planning and design phase of the project. Examples of 

associated costs are construction feasibility study, building plans and specifications, the creation 

of bid documents, and engineering services. 

On line (c) provide the estimated cost of construction. Examples of costs related to construction 

are the independent construction manager, labor, materials, and equipment costs. 

On line (d) provide estimates for state and local permits, compliance monitoring, taxes, 

contingency planning, and any other miscellaneous costs. 

On line (e), the form will sum line items (a) through (d) and place the sub-totals in each column.

On line (f) identify any other available resources from local or state sources. 

The form will subtract line (f) from line (e) and place the result on (g).

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CHILDREN WHO ATTENDED THIS SCHOOL FACILITY AND WHO WERE 

INCLUDED ON TABLES 1 THROUGH 5 OF THE APPLICANT’S SECTION 8003 

APPLICATION

Report on these pages those children included on Tables 1 through 5 of the applicant’s section 

8003 FY 2013 (school year 2011-2012) application who attended the school facility for which 

funding is requested.

FINANCIAL INFORMATION

Please fax (1-866-799-1272) or e-mail (Nyonuwi.Akamefula@ed.gov) audited financial reports 

for the preceding three years with the application. These reports will be used to verify the 

amount of available local funds that could be used for this project in accordance with 34 CFR 

222.192. In cases where matching funds are required, additional documentation of in-kind 

contributions will be requested at that time. The IAP may contact state officials to verify data 

provided by an LEA in this application or in any additional data request, including funds that an 

LEA may receive from a state school construction program.

CONSTRUCTION FEASIBILITY STUDY

For selected applicants requesting funding for new construction, the Impact Aid Program will 

request a feasibility of construction study prior to making an award determination. The 

independent third party study should demonstrate that the area upon which the construction will 

occur is suitable for construction and will be able to sustain the new facility or addition. This 

study should include information to show that the soil it stable and suitable for construction, that 

the existing infrastructure can serve and sustain the new facility. 

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Appendix

Intergovernmental Review of Federal Programs

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, area-wide, 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 #84-041C, U.S. Department of Education, Room 

7W301, 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 12:00 a.m. midnight

(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.

The only official and up to date version of the State Single Point of Contact (SPOC) List is 

posted on the Grants Management section of the OMB web site: 

http://www.whitehouse.gov/omb/grants_spoc/. You are strongly encouraged to access the 

Intergovernmental Review (SPOC List) link to the Grants Management Information section of 

the OMB web page regularly in the course of completing grant applications to be submitted to 

your designated State Single Point of Contact (SPOC). I 

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APPLICATION FOR DISCRETIONARY CONSTRUCTION PROGRAM SECTION 8007(b) - EMERGENCY GRANT

Catalog of Federal Domestic Assistance #84-041C

Send 1 copy to the State Educational Agency (SEA).

*Is the Applicant Delinquent on any Federal Debt?

No

Applicant's

DUNS Number

*Applicant's Taxpayer

Identification Number

Applicant's

Impact Aid Number

*Applicant

Name :

*Street/P.O.Box:

*City:

*County :

*State : Zip: Zip+4:

*Contact Person Name:

*Title:

*Phone:

*Fax:

*E-Mail:

*Name of the School Facility for Which Funding Is Requested: *Amount Requested:

*Enrollment in this School Facility on the Survey Date Reported on Your Local

Educational Agency's(LEA's) Fiscal Year(FY) $preloadData.get('APP_YEAR') Section

8003 Application

If Applicable, Date Application Was Submitted to State Agency for Executive Order 12372 Review:

I certify that I have read the statements contained in this application and that these statements and all of the data included in this application are, to the best of my knowledge and belief, true, complete and correct. I certify that I

am authorized to make the representations and commitments in this application, for and on behalf of the applicant, and otherwise to act as the applicant's authorized representative in submitting this application for funding under

section 8007(b) of the Impact Aid Program (Title VIII of the Elementary and Secondary Education Act). I declare that the applicant will mail a complete copy of this application to the SEA at the same time that it mails this

application to the U.S. Department of Education.

Name and Title of Authorized Representative (Please type or print.) Signature Date

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Application For Discretionary Construction Program - Section 8007(b) - Additional Information

APPLICANT'S INTEREST IN THE

SCHOOL FACILITY

❍ Own

❍ Lease ❍ Other

(Expiration date)

If Other, Specify

IF SPECIAL DISTRICT, SELECT TYPE:

❍ Charter School

❍ Alaskan Rural Education Attendance Area (REAA)

❍ Coterminous District

AGE OF THE SCHOOL FACILITY Year of Original Construction

Year(s) and Description(s) of Major Renovation(s)

Year(s) Description(s)

Square Footage of Existing School Facility

ACREAGE IN LOCAL EDUCATIONAL AGENCY (LEA)

Total Acres Within Boundaries of LEA Total Acres of Nontaxable Federal Property Within Boundaries of LEA

BONDED INDEBTEDNESS AS OF THE END OF THE AGENCY'S FISCAL YEAR

Maximum Bonding Capacity $ Amount of Bonded Debt $

ASSESSED VALUE OF TAXABLE PROPERTY IN LEA

Name of Taxing Jurisdiction (e.g., School District Name, Township Name,

City Name, County Name, etc.)(s)

Total Assessed Value of Real Property (Land and Improvements)

That Was Taxed for School Purposes for school year on Behalf of

the LEA

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Application For Discretionary Construction Program - Section 8007(b) - Project Narrative For Emergency Grant Application

*Proposed Project Start Date *Proposed Project Completion Date

Describe: (1) the emergency condition; (2) how the emergency condition adversely affects the health, safety and well-being of occupants of the school facility; (3) the amount of square footage to be added to the school facility,

if any; (4) the age of the facility systems associated with this project (e.g. roofing, plumbing, HVAC, windows, electrical, etc.); (5) actions the applicant has taken to respond to the emergency condition and why the applicant has

been unable to resolve the condition; (6) how the proposed project will address the emergency condition; and (7) the proposed project and budget.

Title :

File:

Page 13
Title :

Attachment:

File :

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Application For Discretionary Construction Program - Section 8007(b) - Justification For Rebuilding

If proposing new construction, provide justification for rebuilding instead of repairing or renovating the existing school facility. Specify the total square footage of the proposed new facility.

Title :

File:

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Application For Discretionary Construction Program - Section 8007(b) - Cost Estimate Table

Please provide a break down of the cost estimates related to this project.

Budget Category Non-Federal Share Requested Federal Share Total

(a) Direct Project Costs

Supplies

Equipment

Advertisements

Travel/Expenses

(b) Planning /Design/Engineering/ Environmental Impact Study

Facilities Plan

Environmental Documentation

Plans and Specifications

Bid Documents

Engineering Services

(c) Construction /Implementation

Independent Construction Manager

Labor

Materials

Equipment

Other (Specify)

(d) Miscellaneous

Permits

Compliance Monitoring/Oversight/Contingency

Taxes

Other (Specify)

(e) Project Summary (Sum lines (a) through (d) for each column)

(f) Available Resources

State

Local

(g) Total Request (Line (e) minus line (f) for each column)

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Application For Discretionary Construction Program - Section 8007(b) - Children who attended this school facility and who were included on Table 1 of the applicant's Section 8003 application

Report children included on Table 1 of section 8003 FY (school year ) application who attended school facility for which funding is requested.

Federal Property on which children with disabilities reside

Property Code Number

(1)

Official Name, Address, City, State

(2)

Number of

children on

survey date

(3)

Table 1-1 Total =>

Children with disabilities

Category

(5)

Number of children

on survey date

(6)

With a parent on active duty in the uniformed services of the

United States

With a parent who is both an accredited foreign government

official and a foreign military officer

Residing on eligible Indian lands

Table 1-2 Total =>

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Application For Discretionary Construction Program - Section 8007(b) - Children who attended this school facility and who were included on Table 2 of the applicant's Section 8003 application

Report children included on Table 2 of section 8003 FY (school year ) application who attended school facility for which funding is requested.

Children with Disabilities

(2)

Number of children on survey date

(3)

0000-0015 With a parent who is both an accredited foreign government official and a foreign military officer

0000-0015 With a parent who is both an accredited foreign government official and a foreign military officer

Table 2 Total =>

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Application For Discretionary Construction Program - Section 8007(b) - Children who attended this school facility and who were included on Table 3 of the applicant's Section 8003 application

Report children included on Table 3 of section 8003 FY (school year ) application who attended school facility for which funding is requested.

Federal Property on which children reside Federal Property on which parents are employed

Property Code

Number

(1)

Official Name, Address, City, State

(2)

Property Code

Number

(3)

Official Name, Address, City, State

(4)

Number of

children on

survey date

(5)

Table 3 Total =>

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Application For Discretionary Construction Program - Section 8007(b) - Children who attended this school facility and who were included on Table 4 of the applicant's Section 8003 application

Report children included on Table 4 of section 8003 FY (school year ) application who attended school facility for which funding is requested.

Federal Property on which children reside

Property Code Number

(1)

Official Name, Address, City, State

(2)

Number of children on survey date

(3)

Table 4 Total =>

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Application For Discretionary Construction Program - Section 8007(b) - Children who attended this school facility and who were included on Table 5 of the applicant's Section 8003 application

Report children included on Table 5 of section 8003 FY (school year ) application who attended school facility for which funding is requested.

Federal Property on which parents are employed

Property Code Number

(1)

Official Name, Address, City, State

(2)

Number of children on survey date

(3)

Table 5 Total =>

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