HEP Performance Report Grant Year: Y1___ Y2___ Y3___ Y4___ Y5___

Project Name: Sample University Reporting Period: _ _/_ _/20_ _

- _ _/_ _/20_ _ PR Number: S141 A_ _ _ _ _ _ Example of Reporting Period: 07/01/20_ _
– 06/30/20

_



### 1 **The HEP GPRA 1 Documentation Form Directions: Please complete the table below by providing the following information**  **. For**  **Final Performance**  **Reports, the**  **table should**  **reflect the**  **students who**  **attained a**  **high school**  **equivalency (HSE)**  **certification during the Year 5 reporting period.** 

 **Student Name.** Provide the first name, middle initial, and last name of each student who attained a HSE high school equivalency certification during the current reporting period.  **HSE Certificate Number.**  Provide the unique number affixed to the HSE attainer’s certificate.  **The date**  **of the**  **last sub**  **- test**  **taken.** Provide the exact date that the HSE attainer took the last sub

-test in order to pass the HSE
. P rovide this information in the form of Month/Day/Year (e.g. 3/29/2011).  **D id the date of the last sub**  **- test occur during the current reporting period?**  Provide a “Yes” or “No” answer to this question. A ll HSE attainers that you count in this report (all students that are listed on this page) should have taken the last sub

-test d uring the current reporting period. **Student Name HSE**  **Certificate Num**  **ber The**  **date of**  **the**

**last sub**  **- test**  **taken and**  **passed that**  **yielded the**  **HSE certificate**  **(MO/DAY/YR) Did**  **the date**  **of**

**the last**  **sub -** **test occur**  **during the**  **current reporting**  **period? (Yes/No)** 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26.HEP Performance Report Grant Year: Y1___ Y2___ Y3___ Y4___ Y5___

Project Name: Sample University Reporting Period: _ _/_ _/20_ _

- _ _/_ _/20_ _ PR Number: S141 A_ _ _ _ _ _ Example of Reporting Period: 07/01/20_ _
– 06/30/20

_



### 2 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. **Directions: Provide the appropriate signatures below so that the HEP dir ector and HEP**  **authorized representative attest to the accuracy of the information provided above. Please read the statement below and provide the required signatures.**  I have verified and attest to the fact that all students who are listed above were enrolled in the

______________________________ HEP project and attained their HSE during the current reporting period.

________________________________________________________
_________________ (Signature of HEP Director) (Signature Date)

_______ __________________________________________________ _________________ (Signature of HEP Authorized Representative) (Signature Date) This list must be : 1 ) Completed as a Word document; 2 ) S canned into PDF format (to capture authorizing signatures)

; and 3) uploaded into the G5 system as a “Narrative.” Please note that this process is unlike the uploading process for the APR. Instead of being scanned into a PDF, the APR must be converted into a PDF using the Adobe feature an d then uploaded into G5 as a “Narrative.”