OMB Control Number: 1820-0686

Expiration: XX/XX/XXXX

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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. Public reporting burden for this 

collection of information is estimated to average 30 minutes per response, including time for reviewing 

instructions, searching existing data sources, gathering and maintaining the data needed, and completing 

and reviewing the collection of information. The obligation to respond to this collection is required to 

obtain or maintain benefits (Individuals with Disabilities Education Act (IDEA) and its corresponding 

regulations 34 CFR Part 304). Send comments regarding the burden estimate or any other aspect of this 

collection of information, including suggestions for reducing this burden, to the U.S. Department of 

Education, 400 Maryland Ave., SW, Washington, DC 20210-4537 or email ICDocketMgr@ed.gov and 

reference the OMB Control Number 1820-0686. Note: Please do not return the completed Service 

Obligation Pre-Scholarship Agreement to this address.

Service Obligation Pre-Scholarship Agreement

For a Scholarship Received from a Personnel Development to Improve Services and Results for 

Children with Disabilities

Grant Awarded in Fiscal Year 2006 and Any Year Thereafter

Service Obligation Pre-Scholarship Agreement

Between

_____________________________

Name of Scholar

And

______________________________

Name of Grantee
OMB Control Number: 1820-0686

Expiration: XX/XX/XXXX

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Prior to granting a scholarship, the grantee will require each scholar to use the OMB-approved 

Pre-scholarship Agreement in which the scholar agrees to the terms and conditions set forth in the 

regulations published on June 5, 2006 implementing section 662(h) of IDEA (see 34 CFR part 304), 

including the requirement that the Secretary track the service obligations of scholarship recipients. 

The regulations and the Frequently Asked Questions (FAQs) are also available at

http://www.serviceobligations.ed.gov/ProgramRegs2006.cfm, and

http://www.serviceobligations.ed.gov/2006faq.cfm.

According to section 304.23(a), the Secretary may grant a deferral or an exception to the work or 

repayment requirements upon request, if a scholar or an obligee can provide sufficient evidence to 

substantiate eligibility.

The U.S. Department of Education’s address for purposes of this Pre-Scholarship Agreement is:

OSEP PDP Data Collection Center

Grants Awarded in FY2006 and Any Year Thereafter

US Department of Education

Office of Special Education Programs

1600 Research Blvd, RA 1297

Rockville, MD 20850
OMB Control Number: 1820-0686

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To Be Completed by the Grantee

Grant Award Number: H325

Grantee:

Project Title: 

Course of Study or Program:

Project Director:

Date of Scholarship Assistance and Service Obligation Meeting:

Estimated total amount of training in academic years:

Estimated total amount of funding that will be provided:

Date of Enrollment:

Scholar Contact Information

Scholar Name:

Date of Birth:

Social Security Number:

Street Address:

City, State, Zip Code:

Telephone Number:

E-mail Address:

Alternate Scholar Contact Information

Name:

Relationship:

Street Address:

City, State, Zip Code:

Telephone Number:

E-mail Address:
OMB Control Number: 1820-0686

Expiration: XX/XX/XXXX

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To Be Completed by Scholar 

I have read the Service Obligation Regulations, the FAQs and the statements (a) through (i) below:

a) Upon exiting the training program, I must subsequently maintain employment 1) on a full-time or 

full-time equivalent basis; and 2) for a period of at least two years for every academic year for 

which assistance was received;

b) The eligible employment through service obligation must be related to the training received; and

c) I must be employed in a position in which

1) At least 51 percent of the infants, toddlers, and children to whom I provide services are receiving 

special education, related services, or early intervention services from me; 

2) I spend at least 51 percent of my time providing special education, related services, or early 

intervention services to infants, toddlers, and children with disabilities; or 

3) If the position involves supervision including in the capacity of a principal, teaching at the 

postsecondary level, research, policy, technical assistance, program development, or administration, 

I spend at least 51 percent of my time performing work related to the training for which a Special 

Education -- Personnel Development to Improve Services and Results for Children with Disabilities 

program scholarship was received under section 662 of the Act.

d) I cannot repay my service obligation through eligible employment unless I have completed my 

academic training or have completed at least one academic year of training, and if I cannot repay

through eligible employment, I must repay the total amount of funding I have received for my 

training;

e) If I do not fulfill my service obligation through eligible employment, I must repay the total amount 

of funding received for my training or a prorated amount if I have fulfilled a portion of my service 

obligation through eligible employment; 

f) I will inform the US Department of Education of my intention to complete my service obligation 

either through eligible employment or by repaying the total amount of funding received within 30 

days of completion of my training. I have provided the information requested of me in this 

Agreement to the grantee representative;

g) I have completed the Certification of Eligibility for Federal Assistance form (ED 80-0016); 

h) I understand there is no guarantee of federal funding for the duration of my training; and

i) I have agreed to comply with the regulations for the Special Education -- Personnel Development to 

Improve Services and Results for Children with Disabilities program (see 34 CFR part 304), 

including the requirement to provide the information necessary to the Secretary to track my service 

obligation.

______________________________ _______________________________ ____________ 

 Scholar Name Scholar Signature Date

 (Please print)

 
OMB Control Number: 1820-0686

Expiration: XX/XX/XXXX

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To be Completed by Grantee Representative 

I have met with the scholar and discussed the service obligation requirements and provided him/her with a 

copy of the regulations and the FAQs.

____________________________ ___________________________ ___________

 Grantee Representative Name Grantee Representative Signature Date

 (Please print) 

Note: Upon enrollment, the completed Pre-scholarship Agreement must be directly 

entered into the Service Obligation database at http://serviceobligations.ed.gov.