**OM B Approval No.: 1840**  **- 0762**  **Expiration Date: [TBD]**  **Upw ard Bound (UB)**  **and Upw**  **ard Bound Math -**  **Science (UBMS)**

**Annual Performance Report Program Year**  **201 2** 

**– 1**  **3 Authority: Public Law 102**  **- 325, as amended.**  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 co llection of information is estimated to average 8.5 hours 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 retain benefit (Title IV, Sections 402A(c)(2) and 402C of the Higher Education Act of 1965, as amended; the program regula tions in 34 CFR 645, and the Education Department General Administrative Regulations (EDGAR), in 34 CFR 74.51, 75.720, and 75.732). 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 Maryl and Ave., SW, Washington, DC 20202

- 4536 or email ICDocketMgr@ed.gov and reference the OMB Control Number 1840

- 0762. Note: Please do not return the completed annual performance report to this address. **SECTION I , Part 1** 

**– PR** **OJECT IDENTIFICATION, CERTIFICA TION, AND**  **WARNING A.**  **Identification** (all fields with an asterisk [*] are mandatory): 1. PR/Award Number: [will be prepopulated] 2. Name of Grantee Institution/Agency: [will be prepopulated] 3. Address: Campus:

Street:* City:* State:* [dropdown box] Zip:* 4. Name of Project Director: Prefix: [dropdown box allowing choice among Mr., Mrs., Ms., Dr., Sister, Father] First Name:* MI: Last Name:* 5. Telephone Number:* ext.: Fax Number: ext.: E
- mail Address:* 6. Report Pe riod: [will be prepopulated] 7. Type of Project: [will be prepopulated]8. * For UBMS projects only , please indicate whether project is  regional (i.e., serves at least two states) or  non - regional (i.e., operates within a state or a locality). 9. * Proj ect Characteristics

a. Summer residential program (select one below)

____ Yes ____ No ____ Some participants are residential, others commute b. Number of weeks of summer program (insert #) ______ c. Frequency of academic year contacts between project staff and p articipants (select only one) ____Weekly ____Twice a month ____Once a month ____Quarterly ____No face

- to - face contact ____Other :

__________________________________ 10. Data Entry Person: First Name:* MI: Last Name:* Telephone Number:* ext.: If you woul d like to receive an e

- mail confirmation upon receipt of your Annual Performance Report, please enter your e

- mail address: **B. Certification**  The Project Director and Certifying Official are required to sign and date Section I , Part 1 of the 201 2

– 1 3 Annual Performance Report form to certify the accuracy and completeness of the information submitted electronically. After completing the entire report online, you will be able to print a copy of Section I, Part 1, which will include signature lines for the pro ject director and certifying official. Please print and fax SECTION I , PART 1 only to the U. S. Department of Education at 703
- 832
- 1360 . Please use the Print button provided on the Submit page. Please review the information in this section for accuracy and make needed changes before proceeding to the next section of the report form.  I have verified the information in this section. **C. Warning**  Any person who knowingly makes a false statement or misrepresentation on this report is subject to penalties which may include fines, imprisonment, or both, under the United States Criminal Code and 20 U.S.C. 1097. Further federal funds or other benefits may be withheld under these programs unless this report is completed and filed as required by existing law (2 0 U.S.C. 1231a) and regulations (34 CFR 75.590 and 75.720)**SECTION I , Part 2:**  **Competitive Preference Priorities**  **(If Applicable)**

The 2012 UB and UBMS grant competitions established three competitive preference priorities concerning persistently lowest

- achieving schools, data

- based decision

- making, and improvements in productivity. The Department will derive data for the first competitive preference, concerning projects’ service to persistently lowest

- achieving schools , from the “Target School

— NCES Identification Number” field (#26) in Section II, which provides identifying information on the target school attended by each participant. Below, please i ndicate whether your project addressed the remaining two competitive preference priorities. For each pr iority addresse d, please complete the text boxes with concise information about implementation. **Competitive Preference Priority #2:** The Secretary encourages applicants to work with appropriate State agencies to use data from State longitudinal data s ystems or to obtain data from reliable third

-party sources when providing information on the implementation of their UB/UBMS projects and their participants’ outcomes. 1A. Not applicable □ 1B. Yes □ If “Yes , ” indicate below which data systems your project utilized. **State longitudinal data systems Third**  **- party data systems** 

**Competitive Preference Priority #3:** The Secretary encourages applicants to design projects that serve the same or increased number of students at a lower cost per particip ant while improving or keeping steady student outcomes. 3A. Not applicable □ 3B. Yes □ If “Yes”, indicate below how your project achieved this productivity by increasing efficiency in the use of time, staff, money or other resources. **Resource/Measure used with**  **increased efficiency Improved Outcome**