**OM B N**  **o 1845 -**  **0030 Expires:** 

**FISA P Version:**  **Page A -**  **1** 

### Paperwork Burden Statement According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless su ch collection displays a valid OMB control number. The valid OMB control number for this information collection is **1845 -**  **0030** . The time required to complete this information collect ion is estimated to average 20.91 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 - 4537. **If you have comments or concerns regarding the status of your i** 

**ndividual submission of this form, write directly to:** Grants & Campus - Based Division, Federal Student Aid, Union Center Plaza, 8 30 First Street, NE, Washington, D.C. 20202. 

# Fiscal Operations Report and A **pplication to Participate (FIS AP)**  **Report: Award Year July 1, 2012 through June 30, 2013**  **; Application: Award Year July 1, 2014**  **through June 30, 2015** Part I. Identifying Information, Certification and W arning Section A. Identifying Information **1(a) Name and address of school**



### __________________________________________________

__________________________________________________

__________________________________________________

_____ _____________________________________________ **2. OPEID Number**



### _____________________ **3. Ty pe of school (select one)**  __ 3.1 public __ 3.2 private/non - profit __ 3.3 proprietary **(Select one if**  **proprietary )** 

__ (a) art

__ (b) business

__ (c) cosmetology
__ (d) trade and technical
__ (e) other **5. Additional Institutions**  If the data reported on this form applies to more than one eligible institution (unique 8 - digit Institution OPEID not an OPEID that identifies an additional location ), you must identify all institutions for which this form is applicable. **This is a change**  **– S**  **ee instructions 1(b) Mailing address (if different from 1(a))** 



### __________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________ **4. Length/ty pe of longest program (select one)**  __ 4.1 less than 1 year __ 4.2 1 year but less than 2 years __ 4.3 2 years but less than 3 years __ 4.4 3 years but less than 4 years __ 4.5 4 years (no higher than a baccalaureate degree) __ 4.6 5 years or more __ 4.7 post - baccalaureate on ly

This FISAP includes data for additional ins t itutions.

. __ yes

__ no
**6. Financial Aid Administrator** Name



### _____________________________ Telephone No.



### ______________ E - mail address



### _____________________________ Fax No.



### ______________ **7. Name and address of private financial aid consultant firm, if any** Name



### _____________________________________________ Address 1



### _____

________________________________________ Address 2



### _____________________________________________ City



### ____________________ State



### ______ Zip



### ____________**OM B no 1845**  **- 0030**  **Expires 06/30/2016**

**FISA P Version:**  **Page A -**  **2** 

## Section B. Certification and Warning Name of S chool _____________________________________________________ OPEID Number

_________ State

_______ **Ap plicants must review the requirements for certification regarding lobbying included in the regulations**  **cited below before completing this form. A pplicants must**  **sign this form to comply with the certification requirements under 34 CFR Part 82, “New Restrictions on Lobbying.” This certification is a material**  **representation of fact upon which the Department of Education relies when it makes a grant or enters into a**  **cooperative agreement.** As required by Section 1352, Title 31 of the U.S. Code, and implemented at 34 CFR Part 82, for persons entering into a Federal contract, grant or cooperative agreement over $100,000, as defined at 34 CFR Part 82, Sections 82.105 an d 82.110, the applicant certifies that: (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congre ss, an officer or employee of Congress, or an employee of a Member of Congress in connection with the making of any Federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, am endm ent, or modification of any F ederal grant or cooperative agreement; (b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agenc y, a Mem ber of Congress, an officer or em ployee of Congress, or an employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, “Disclosure Form to Report Lobbying,” in accordance with its instruct ions ; and (c) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subgrants and contracts under grants and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. **As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certification. I further certify that the information contained in this electronic FISA**  **P is in compliance with governing legislation and regulations and is true and accurate.**  I understand that all information associated with this FISAP is subject to audit and program review by representatives of the Secretary of Education. **WA RNING:**  

## If you purposely give false or misleading information, y ou may be fined up to $20,000, sent to prison, or both. **8. Chief Executive Officer (includes President, Chancellor, and Director)** Signature 

## _________________________________ Date signed



## _______________ Name 

## ____________________________________ Telephone No.



## ____________ Title 

## _____________________________________ Fax No.



## _________________ E - mail address 

## _____________________________ 

# Mail signed form to: **FISA P A**  **dministrator 31**  **3 0 Fairview**  **Park Drive Suite**  **800 Falls Church, VA**  **22042 OM**  **B no 1845**  **- 0030**  **Expires 06/30/2016**

**FISA P Version:**  **DO NOT SEND THESE PA GES TO THE DEPA**  **RTMENT Page A**  **- 3**  

# Ap **plication to Participate, Part II** Name of S chool _____________________________________________________ OPEID Number _________ State

_______ 

## Part II. Application to Participate for Award Y ear July 1, 2014 through June 30, 2015 Section A. Request for Funds for the 2014 - 2015 Award Year **1. Federal Perkins Loan Level of Expenditures $** 



### _________ **2. Federal Perkins Loan Federal Capital Contribution $** 



### _________ **3. FSEOG federal funds $** 



### _________ **4. FWS federal funds $** 



### _________ 

## Section B. Federal Perkins Loan Program Liquidation Request (Applies only to certain schools; see instructions) **5. My school wishes to discontinue participation in the Federal Perkins Loan Program.** 



### __ **ye s** 



### __ **no** 

## Section C. Waiver Request for the Underuse of Funds **My school has returned more than 10 percent of its Federal Perkins Loan, FSEOG, or FWS allo**  **cation for the 2012**  **- 2013**  **award year. 6. My**  **school wishes to apply for a waiver of the penalty for the underuse of funds and will provide, on the Additional**  **Information screen, a written explanation of the circumstances.**



### __ **ye s** 



### __ **no OM**  **B no 1845 -**  **0030 Expires 06/30/**  **2016**

**FISA P Version:**  **DO NOT SEND THESE PA GES TO THE DEPA**  **RTMENT Page A**  **- 4**  

# Ap **plication to Participate, Part II (continued)** Name of S chool _____________________________________________________ OPEID Number _________ State

_______ 

## Part II. Application to Participate for Award Year July 1, 2014 through June 30, 2015 Section D. Information on Enrollment **My school’s calendar is __Traditional __Non**  **- Traditional**  **Schools with a traditional calendar that had 20 12**  **- 2013 enrollment, fill in Field 7.**  7. Total number students, 2012 - 2013 (a) Undergraduate ____________ (b) Graduate/Professional ____________ 

### Schools with a traditional calendar that did not have 2012 **- 2013 enrollment, fill in Field 8.**  8. Estimated number students, 2013 - 2014 (a) Undergraduate ____________ (b) Graduate/Professional ____________ 

### Schools with a non **- traditional calendar that had**  **2012 -**  **2013 enrollment, fill in fields 9 through 20.**  **Undergraduate Undergraduate**  **Graduate/Professional Gradua**  **te/Professional Continuing Students**  **New Starts Continuing Students**  **New Starts (a)**  **(b) (c)**  **(d)** 9. July 1, 2012

____________ ____________ ____________ ____________ 10. August 1

____________ ____________ ____________ ____________ 11. September 1

____________ ____________ ____________ ____________ 12. October 1

____________ ____________ ____________ ____________ 13. November 1

____________ ____________ ____________ ____________ 14. December 1

____________ ____________ ____________ ____________ 15. January 1, 2013

____________ ____________ ____________ ____________ 16. February 1

____________ ____________ ____________ ____________ 17. March 1

____________ ____________ _______ _____ ____________ 18. April 1

____________ ____________ ____________ ____________ 19. May 1

____________ ____________ ____________ ____________ 20. June 1

____________ ____________ ____________ ____________ 21. TOTAL

____________ ______ ______ ____________ ____________ 

## Section E. Assessments and Expenditures **Undergraduate (a)**  **Graduate/Professional (b)**  22. Total tuition and fees for the award year July 1, 201 2 to June 30, 201 3 

### $



### ____________ $



### ____________ 23. Total Federal Pell Grants expenditures for the 2012 - 2013 award year 

### $



### ____________ 24. Total expended for state grants and scholarships made to undergraduates for the award year July 1, 2012 to June 30, 2013 

### $



### ____________ 

## Section F. Information on Eligible Aid Applicants Enrolled in Your School for Award Year 2012 - 2013 **Dependent Undergraduate Independent Undergraduate**  **Independent** Without Baccalaureate/ With Baccalaureate Without Baccaluareate/ With Baccalaureate/ Graduate/ 1 st Prof. Degree (a) 1 st Prof. Degree (b) 1 st Prof Degree (c) 1 st Prof. Degree (d) Professional (e) 25. Students with an “Automatic” Zero EFC

____________ _______ _____ ____________ ____________ ____________ 

### Taxable and Untaxed Income **Taxable and Untaxed Income** 26. $0 - $2,999

___________ _______ _ ___ $0 - $999

_____ _ _____ _________ __ ___________ 27. $3,000 - $5,999

___________ ________ _ __ $1,000 - $1,999

______ _ ____ ________

__ _ ___________ 28. $6,000 - $8,999

___________ _________ _ _ $2,000 - $2,999

_______ _ ___ _________

__ ___________ 29. $9,000 - $11,999

___________ __________ _ $3,000 - $3,999

________ _ __ _________

__ ___________ 30. $12,000 - $14,999

___________ __________ _ $4,000 - $4,999

_________ _ _ _________

__ ___________ 31. $15,000 - $17,999

___ ________ __________ _ $5,000 - $5,999

___________ _________ __ ___________ 32. $18,000 - $23,999

___________ __________ _ $6,000 - $7,999

___________ _________ __ ___________ 33. $24,000 - $29,999

___________ __________ _ $8,000 - $9,999

___________ _________ __ ___________ 34. $30,000 - $35,999

___________ __________ _ $10,000 - $11,999

___________ _________ __ ___________ 35. $36,000 - $41,999

______ _____ __________ _ $12,000 - $13,999

___________ _________ __ ___________ 36. $42,000 - $47,999

___________ __________ _ $14,000 - $15,999

___________ _________ __ ___________ 37. $48,000 - $53,999

___________ __________ _ $16,000 - $17,999

___________ _________ __ ___________ 38. $54,000 - $59,999

___________ __________ _ $18,000 - $19,999

___________ _________ __ ___________ 39. $60,000 and over

___________ _________ _ _ $20,000 and over

___________ _________ __ ___________ **40. TOTAL** 

___________ __________ _ **TOTAL**

___________ _________ __ ___________**OM B no 1845**  **- 0030**  **Expires 06/30/ 2013** 

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# Fiscal Operations Report, Part III Name of S chool _____________________________________________________ OPEID Number _________ State

_______ 

## Part III. Federal Perkins Loan Program for Award Year July 1, 2012 through June 30, 2013 Section A. Fiscal Report (Cumulative) as of June 30, 2013 **Field Item** 

### Amount **Number of Borrowers Debit Balances Credit Balances** (a) 

### (b) **(c) (d)**  1.1. Cash on hand and in depository as of 6/30/2013 

### $



### __________ 1.2. Cash on hand and in depository as of 10/31/2013 

### $



### ____ __ ___ 2. Funds receivable from federal government 

### $



### __________ 3. Funds receivable from school 

### $



### __________ 4. Funds advanced to students



### _________________ $



### __________ 5. Loan principal collected



### _________________ $



### __________ 6. Loan principal assigned to an d accepted by the United States



### _________________ $



### __________ Loan principal canceled for the following categories : 7. teaching/military service (applies to loans made prior to

07/01/1972) 

### _________________ $



### __________ 8. certain subject matter teaching service (math,

science, foreign languages, bilingual education)



### _________________ $



### __________ 9. all other authorized pre - K or K - 12 teaching service



### _________________ $



### __________ 10. military service (applies to loans made 07/01/1972 an d after) 

### _________________ $



### __________ 11. volunteer service



### _________________ $



### __________ 12. law enforcement and corrections officer service



### _________________ $



### __________ 13. child/family/early intervention serv ice



### _________________ $



### __________ 14. nurse/medical technician service

____________________ $____________ 15. pre - K or child care program staff member service

____________________ $____________ 16. service as an attorney in a public defender organization

______ ______________ $____________ 17. fire fighter service

____________________ $____________ 18. Tribal College or University faculty service

____________________ $____________ 19. librarian service

____________________ $____________ 20. speec h - language pathology service

____________________ 

### $



### __________ 21. death/disability



### _________________ $



### __________ 22. disability based on VA determination

_____________________ $____________ 23. bankruptcy



### _________________ $



### __________ 24. surviving spouses of public service victims of 9 - 11 terrorist attacks



### _________________ $



### __________ 25. loans discharged due to closed schools



### _________________ $



### __________ 26. Loan principal adjustments – other



### _________________ $



### __________ 27. Federal Capital Contributions 

### $



### __________ 28. Repayments of fund capital to federal government 

### $



### __________ 29.1. Short - term loans to the Fund $_______

___ _ 29.2. ICC deposited to the Fund $________

___ 29.3. Institutional Capital Contribut ions 

### $



### __________ 30.1. Repayment of short - term loans to the fund $________

___ 30.2. Distribution of excess/liquidated fund capital $________

___ 30.3.Repayments of fund capital to school 

### $



### __________ 31. Interest income on loans 

### $



### __________ 32. Other income 

### $



### __________ 33. Reimbursements to the Fund of the amounts canceled

on loans made 07/01/1972 and after 

### $



### __________ 34.1. Administrative cost allowance 

### $



### _______ _ _ 34.2. Collection costs 

### $



### ________ _ 34.3. Administrative cost allowance and collection costs (control) 

### $



### __________ Cost of loan principal and interest canceled for the following categories : 35. teaching/military service (applies to loans made prior to

07/01/1972) 

### $



### __________ 36. certain subject matter teaching service (math, science,

foreign languages, bilingual education) 

### $



### __________ 37. all other authorized pre - K or K - 12 teaching service (applies to loans made

07/01/1972 and after) 

### $



### __________ 38. military service (applies to loans made 07/01/1972 and after) 

### $



### __________ 39. volunteer service in the Peace Corps or under the

Domestic Volunteer Serv ice Act of 1973 

### $



### __________**OM B no 1845**  **- 0030**  **Expires 06/30/ 2013** 

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# Fiscal Operations Report, Part III (continued) Name of S chool _____________________________________________________ OPEID Number _________ State

_______ 

## Part III. Federal Perkins Loan Program for Award Year July 1, 2012 through June 30, 2013 Section A. Fiscal Report (Cumulative) as of June 30, 2013 **Field Item** 

### Amount **Number of Borrowers Debit Balances Credit Balances**  (a) 

### (b) **(c) (d)**  40. law enforcement and corrections officer service 

### $



### __________ 41. child/family/early intervention service 

### $



### __________ 42. nurse/medical technician service 

### $



### __________ 43. pre - K or child care program staff member service $__

__________ 44. service as an attorney in a public defender organization $____________ 45. fire fighter service $____________ 46. Tribal College or University faculty service $____________ 47. librarian service $____________ 48. speech - language pathology service $____________ 49. death/disability 

### $



### __________ 50. VA disability determination $____________ 51. bankruptcy 

### $



### __________ 52. surviving spouses of public service victims of 9 - 11 terrorist a ttacks 

### $



### __________ 53. Cost of loan principal and interest assigned to and accepted by the United States 

### $



### __________ 54. Cost of loan principal and interest canceled for loans discharged due to closed schools 

### $



### __________ 55. Other costs or losses 

### $



### __________ 56. Balancing Adjustments (Debits) 

### $



### __________ 57. Bala ncing Adjustments (Credits) 

### $



### __________ 58. Total debits and credits (Sum of fields 1.1 through 57) 

### $



### __________ $



### __________ 

## Section B. Fund Activity (Annual) During the 2012 - 2013 Award Year (July 1, 2012 through June 30, 2013 ) **Number of Borrowers Amount**  **(a) (b)**  1. Final adjusted Federal Capital Contribution (FCC) authorization 

### $ 

### __________ 2. F WS funds transferred to the Fund +$____________ 3. FCC transferred to: (a) FSEOG - 

### $



### __________ (b) FW S - 

### $ 

### __________ 4. Total federal funds available for the 2012 - 2013 award year (fields 1 + 2 – 3(a) – 3(b)) $___________ 5. The unexpended amount of final adjusted authorized FCC for award year 2012 - 2013 that was NOT requested from G5 by June 30, 2013. This amount will be reduced from your total award amount next spring (see instructions). 

### $ 

### __________ 6. Institutional Capital Contribution (ICC) deposited into the Fund between July 1, 2012 and June 30, 2013 

### $



### __________ 7. Loans advanced to students from the Fund during the 2012 - 2013 award year (minus 2012 - 2013 award year refunds) 

### $



### __________ 8. Administrative cost allowance claimed for the 2012 - 2013 award year (see instructions) 

### $



### __________ 9. Total principal and interest repaid by borrowers from all sources during the 2012 - 2013 award year



### _________________ $



### __________ 10. Total principal repaid by borrowers from all sources during the 2012 - 2013 award year for loans in default for more than 2 years but not more than 5 years



### _________________ $



### __________ 11. Total pr incipal repaid by borrowers from all sources during the 2012 - 2013 award year for loans in default for more than 5 years



### _________________ $



### __________**OM B no 1845**  **- 0030**  **Expires 06/30/ 2013** 

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# Fiscal Operations Report, Part III (continued) Name of S chool _____________________________________________________ OPEID Number _________ State

_______ 

## Part III. Federal Perkins Loan Program for Award Year July 1, 2012 through June 30, 2013 Section C. Cumulative Repayment Information as of June 30, 2013 **Status of Borrowers as of June 30, 2013**  **Am ount**  **Number of Am**  **ount Lent Principal A**  **mount Borrowers**  **Outstanding (a)**  **(b) (c)**  **(d)** 1.1. Borrowers whose loans are fully retired



### ________ $



### __________ 1.2. Loans that have been purchased 

### $



### ___ __ ____ 2. Borrowers whose loans were assigned to and officially accepted by the U.S. Department of Education as of June 30, 2013 (Note: Field 2 equals the sum of Field 2.1 plus Field 2.2.)



### ________ $



### __________ $



### ____________ 2.1. Assignments due to default or liquidation



### ________ $



### __________ $



### ____________ 2.2. Assignments due to total and permanent disability discharge



### ________ $



### __________ $



### ____________ 3. Total borrowers not in repayment status



### ________ $



### ____________ 4. Borrowers on schedule in repayment status



### ________ $



### ____________ 5.1. In default less than 240 days (monthly installments) or less than 270 days (other installments)



### ________ $



### __________ $



### ____________ 5.2. In default 240 days or more (monthly installments) or 270 days or more (other installments), up to 2 years



### ________ $



### __________ $



### ____________ 5.3. In default more than 2 years but not more than 5 years



### ________ $



### __________ $



### ____________ 5.4. In default more than 5 years



### ________ $



### __________ $



### ____________ **Cohort Default Rate (Sections D and E)**  **Schools with fewer than 30 borrowers who entered repay ment in the**  **2011 -**  **2012 award y**  **ear should skip to Section E.** 

## Section D. Schools with 30 or More Borrowers Who Entered Repayment in the 2011 - 2012 Award Year 1.1. Number of borrowers who entered repayment in 2011 - 2012



### __________________________ 1.2. Number of borrowers from Field 1.1 above with loans in default by June 30, 2013



### __________________________ 1.3. Cohort defaul t rate ((Field 1.2 / Field 1.1) x 100)



### __________________________ 

## S ection E. Schools with Fewer than 30 Borrowers Who Entered Repayment in the 2011 - 2012 Award Year 2.1. Number of borrowers who entered repayment in: 2.2. Number of borrowers with loans in default by: (a) 2009 - 2010 (07/01/2009 - 06/30/2010)



### __________ (a) June 30, 2011(those in 2.1(a) only)



### __________ (b) 2010 - 2011 (07/01/2010 - 06/30/2011)



### __________ (b) June 30, 2012 (those in 2.1(b) only)



### __________ (c) 2011 - 2012 (07/01/2011 - 06/ 30/2012)



### __________ (c) June 30, 2013 (those in 2.1(c) only)



### __________ 2.3. Total number of borrowers who entered repayment during the three years above (fields 2.1(a) + 2.1(b) + 2.1(c))



### __________ 2.4. Total number of borrowers with loans in default during the three years above (fields 2.2(a) + 2.2(b) + 2.2(c))



### __________ 2.5. Cohort default rate ((Field 2.4 / Field 2.3) x 100)



### __________**OM B no 1845**  **- 0030**  **Expires 06/30/ 2013** 

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# Fiscal Operations Report, Part IV Name of S chool _____________________________________________________ OPEID Number _________ State

_______ 

## Part IV. Federal Supplemental Educational Opportunity Grant (FSEOG) Program for Award Year July 1, 2012 through June 30, 2013 Section A. Federal Funds Authorized for FSEOG 1. Final adjusted FSEOG authorization 

### $



### ____________ 

## Section B. Federal Funds Available for FSEOG Expenditures 2. FW S funds transferred to and spent in FSEOG + 

### $



### ____________ 3. Federal Perkins Federal Capital Contribution fund s transferred to and spent in FSEOG + 

### $



### ____________ 4. FSEOG funds transferred to and spent in FWS 

### - $___________ 5. 2013 - 2014 FSEOG funds carried back and spent in 2012 - 2013 + 

### $



### ____________ 6. Additional 2013 - 2014 FSEOG funds carried back and spent for 2013 summer enrollment + 

### $



### ____________ 7. 2011 - 2012 funds carried forward and spent in 2012 - 2013 + 

### $



### ____________ 8. 201 2 - 201 4 funds carried forward to be spent in 2013 - 2014 - 

### $



### ____________ 9. 2012 - 2013 funds carried back and spent in 2011 - 2012 - 

### $



### ____________ 10. Additional 2012 - 2013 funds carried back and spent for 2012summer enrollment - 

### $



### ____________ 11. Total federal funds available for 2012 - 2013 FSEOG (fields 1 + 2 + 3 + 5 + 6 + 7) minus (fields 4 + 8 + 9 + 10) 

### $



### ____________ 

## Section C. Funds to FSEOG Recipients 12. Total funds to FSEOG recipients (fields 13 + 14) 

### $



### ________ ____ 13. Nonfederal share of funds to FSEOG recipients (25 percent of Field 12) 

### $



### ____________ (a) Cash outlay contributed 

### $



### ____________ (b) Other resources designated 

### $



### ____________ 

## Section D. Federal Funds Spent for FSEOG Program 14. Fe deral share of funds to FSEOG recipients (75 percent of Field 12) 

### $



### ____________ 15. Administrative cost allowance claimed (see instructions) + 

### $



### ____________ 16. Federal funds spent for FSEOG (fields 14 + 15) 

### $



### ____________ 

## Section E. Use of FSEOG Authoriz ation 17. Expended FSEOG authorization (fields 4 + 8 + 9 + 10 + 16) minus (fields 2 + 3 + 5 + 6 + 7) 

### $



### ____________ 18. Unexpended FSEOG authorization (Field 1 - Field 17) (cannot be negative) 

### $



### ____________**OM B no 1845**  **- 0030**  **Expires 06/30/ 2013** 

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# Fiscal Operations Report, Part V Name of S chool _____________________________________________________ OPEID Number _________ State

_______ 

## Part V. Federal Wo rk - Study (F WS ) Program for Award Year July 1, 2012 through June 30, 2013 Section A. Federal Funds Authorized for FWS 1. Final adjusted FWS authorization 

### $



### ____________ 

## Section B. Federal Funds Available for FWS Expenditures 2. Federal Perkins Federal Capital Contribution funds transferred to and spent in FWS + 

### $



### ____________ 3. FSEOG funds transferred to and spent in FWS +$_____________ 4. FW S funds transferred to and spent in: (a) FSEOG - $____________ (b) Federal Perkins Loan Program 

### - $___________ 5. 2013 - 2014 FW S funds carried back and spent in 2012 - 2013 + 

### $



### ____________ 6. Additional 2013 - 2014 FW S funds carried back and spent for 2013 summer employment + 

### $



### ____________ 7. 2011 - 2012 funds carried forward and spent in 2012 - 2013 + 

### $



### ____________ 8. 2012 - 2013 funds carried forward to be spent in 2013 - 2014 - 

### $



### ____________ 9. 2012 - 2013 funds carried back and spent i n 2011 - 2012 - 

### $



### ____________ 10. Additional 2012 - 2013 funds carried back and spent for 2012 summer employment - 

### $



### ____________ 11. Total federal funds available for 2012 - 2013 FW S (fields 1 + 2 + 3 + 5 + 6 + 7) minus (fields 4(a) + 4(b) + 8 + 9 + 10) 

### $



### ____________ 

## Section C. Total Compensation for FWS 12. Total earned compensation for FWS Program 

### $



### ____________ (a) On - campus earned compensation 

### $



### ____________ (b) Off - campus earned compensation for public or priv ate non - profit agencies, excluding amounts reported in Field 12(c) 

### $



### ____________ (c) Off - campus earned compensation for agencies that were unable to pay regular nonfederal share and had a federal share up to 90 percent 

### $



### ____________ (d) Off - campus earned compensation for private for - profit organizations 

### $



### ____________ 13. Total institutional share of earned compensation (see instructions) 

### $



### ____________ 

## Section D. Funds Spent from Federal Share of FWS 14. Total federal share of FWS earned compensation 

### $



### ____________ ( a) Federal share paid at a rate up to 75 percent 

### $



### ____________ ( b) Federal share paid at a rate up to 100 percent for waivers of nonfederal share 

### $



### ____________ ( c) Federal share paid at a rate up to 90 percent for agencies that were unable to pay regular nonfederal share 

### $



### ____________ ( d) Federal share paid at a rate up to 50 percent for off - campus, private for - profit organizations 

### $



### ____________ 15. Administrative cost allowance claimed (see instructions) + 

### $



### ____________ 16. Federal share of Job Location and Development (JLD) Program expenditures + 

### $



### ____________ 17. T otal federal funds spent for FWS (fields 14 + 15 + 16) 

### $



### ____________**OM B no 1845**  **- 0030**  **Expires 06/30/ 2013** 

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# Fiscal Operations Report, Part V (continued) Name of S chool _____________________________________________________ OPEID Number _________ State

_______ 

## Part V. Federal Wo rk - Study (F WS ) Program for Award Year July 1, 2012 through June 30, 2013 Section E. Use of FWS Authoriz ation 18. Expended FW S authorization (fields 4(a) + 4(b) + 8 + 9 + 10 + 17) minus (fields 2 + 3 + 5 + 6 + 7) 

### $



### ____________ 19. Unexpende d FW S authorization (Field 1 - Field 18) 

### $



### ____________ 

## Section F. Information About the Job Location and Development (JLD) Program 20. Total expenditures for the JLD Program 

### $



### ____________ 21. Institutional expenditures for the JLD Program (see instructions) 

### $



### ____________ 22. Number of students for whom jobs were located or developed



### ____________ 23. Total earnings of the students in Field 22 above 

### $



### ____________ 

## Section G . Information About FWS Students Employed in Community Service Activities 24. Number of students in community service employment



### _____________ 25. Federal share of community service earned compensation 

### $



### ____________ 26. Nonfederal share of community service earned compensation 

### $



### ____________ 

## Section H. Information About FWS Students Employed as Reading Tutors of Children or Employed in

Family Literacy Activities 27. Number of FWS students employed as reading tutors of children or employed in family literacy activities



### _____________ 28. Federal share of earned compensation for FWS students employed as reading tutors of children or employed in family literacy activities 

### $



### ____________ (a) Amount of the federal share in Field 28 spent on community service em ployment 

### $



### ____________ 29. Total earned compensation for FWS students employed as reading tutors of children or employed in family literacy activities 

### $



### ____________ 

## Section I. Information About FWS Students Employed as Mathematics Tutors of Children 30. Number of FWS students employed as mathematics tutors of children



### _____________ 31. Federal share of earned compensation for FWS students employed as mathematics tutors of children 

### $



### ____________ 32. Total earned compensation for FWS students employed as mathematics tutors of children 

### $



### ____________ 

## Section J. Information About FWS Students in Civic Education and Participation Activities 33. Number of students in civic education and participation activities

_______________ 34. Federal share spent for students in civic education and participation activities $______________ 35. Total spent for students in civic education and participation activities $______________ 

## Section K. Information About FWS Disaster - Affected Students 36. Number of disaster - affected students receiving FWS funds

____________ __ _ 37. Federal share of funds to disaster - affected students $___________

___ 38. Total funds to disaster - affected students $___________

__ _**OM B no 1845**  **- 0030**  **Expires 06/30/ 2013** 

**FISA P Version:**  **DO NOT SEND THESE PA GES TO THE DEPA**  **RTMENT Page A**  **- 11**  

# Fiscal Operations Report, Part VI Name of S chool _____________________________________________________ OPEID Number _________ State

_______ 

## Part VI. Program Summary for Award Year July 1, 2012 through June 30, 2013 Section A. Distribution of Program Recipients and Expenditures by Type of Student **Taxable and Untaxed Federal Perkins Loan FSEOG**  **FWS Unduplicated**  

### Income Category **Recipients Funds Recipients Funds Recipients Funds Recipients** 

### Student Ty **pe (a)**  **(b) (c) (d) (e)**  **(f) (g)**  

### Undergraduate **Dependent** 1. $0 - $ 5,999



### _________ _________ _________ _________ _________ _________ _________ 2. $6,000 - $11,999



### _________ _________ _________ _________ _________ _________ _________ 3. $12,000 - $23,999



### _________ _________ _________ _________ _________ _________ _________ 4. $24,000 - $29,999



### _________ _________ _________ _________ _________ _________ _________ 5. $30,000 - $41,999



### _________ _________ _________ _________ _________ _________ _________ 6. $42,000 - $59,999



### ____ _____ _________ _________ _________ _________ _________ _________ 7. $60,000 - $69,999



### _________ _________ _________ _________ _________ _________ _________ 8. $70,000 - $79,999



### _________ _________ _________ _________ _________ _________ _________ 9. $80,000 - $89,999



### _________ _________ _________ _________ _________ _________ _________ 10. $90,000 - $99,999



### _________ _________ _________ _________ _________ _________ _________ 11. $100,000 and over



### _________ _________ _________ _________ _________ _________ _________ **Undergraduate Independent**  12. $0 - $ 1,999



### _________ _________ _________ _________ _________ _________ _________ 13. $2,000 - $ 3,999



### _________ _________ _________ _________ _________ _________ _________ 14.. $4,000 - $ 7,999



### _________ _________ _________ ______ ___ _________ _________ _________ 15. $8,000 - $11,999



### _________ _________ _________ _________ _________ _________ _________ 16. $12,000 - $15,999



### _________ _________ _________ _________ _________ _ ________ _________ 17. $16,000 - $19,999



### _________ _________ _________ _________ _________ _________ _________ 18. $20,000 - $24,999



### _________ _________ _________ _________ _________ _________ _________ 19. $25,000 - $29,999



### _________ _________ _________ _________ _________ _________ _________ 20. $30,000 - $34,999



### _________ _________ _________ _________ _________ _________ _________ 21. $35,000 - $39,999



### _________ _________ _________ _________ _________ _________ _________ 22. $40,000 and over



### _________ _________ _________ _________ _________ _________ _________ 23. Graduate/Professional



### _________ _________ does not apply does not apply



### _________ _________ _________ **24 .**  

### TOTAL **(fields 1 -**  **23 )** 



### _________ _________ _________ _________ _________ _________ _________ **25 . Total less**  **- than**  **- full**  **- time**  **students (from fields 1**  **- 23**  **)**



### _________ _________ _________ _________ _________ _________ _________ **26 . Total “A**  **utomatic” Zero EFC students**  **(f rom fields 1**  **- 23**  **)**



### _________ _________ _________ _________ _________ _________ _________**OM B no 1845**  **- 0030**  **Expires 06/30/ 2013** 

**FISA P Version:**  **DO NOT SEND THESE PA GES TO THE DEPA**  **RTMENT Page A**  **- 12**  

# Fiscal Operations Report, Part VI (continued) Name of S chool _____________________________________________________ OPEID Number _________ State

_______ 

## Part VI. Program Summary for Award Year July 1, 2012 through June 30, 2013 Section B. Calculating the Administrative Cost Allowance **Ad ministrative Cost A**  **llowance Worksheet (Worksheet must be retained for audit and program reviews) Step 1. Calculate the amount spent in**  **2012 -**  **2013 on which the administrative cost allowance is based.**  1. Total compensation in FWS (amount from Part V, Section C, Field 12) 

### $



### ____________ 2. Amount of Federal Perkins Loan funds advanced to students (amount from Part III, Section B, Field 7) + 

### $



### ____________ 3. Total funds to FSEOG recipients (amount from Part IV, Section C, Field 12) + 

### $



### ____________ 4. Total amount spent (fields 1 + 2 + 3) 

### $



### ____________ **Step 2. Calculate the administrative cost allowance. Schools whose total amount spent was $2,750,000 or less**  5. Enter t otal amount spent (Field 4) 

### $



### ____________ 6. Multiply 

### x 0.05 7. Total administrative cost allowance — go to Step 3 

### $



### ____________ **Schools whose total amount spent was more than $2,750,000 but less than $5,500,000** 8. Enter total amount spent (Field 4) 

### $



### ____________ 9. Subtract - 

### $ 2,750,000 10. Expenditures over $2,750,000 (Field 8 - Field 9) 

### $



### ____________ 11. Multiply 

### x 0.04 12. Administrative cost allowance on expenditures over $2,750,000 (Field 10 x Field 11) 

### $



### ____________ 13. Add administrative cost allowance on expenditures of $2,750,000 ($2.75 million x .05) + 

### $ 137,500 14. To tal administrative cost allowance (Field 12 + Field 13) — go to Step 3 

### $



### ____________ **Schools whose total amount spent was $5,500,000 or more** 15. Enter total amount spent (Field 4) 

### $



### ____________ 16. Subtract - 

### $ 5,499,999 17. Expenditures of $5,500,000 or more (Field 15 - Field 16) 

### $



### ____________ 18. Multiply 

### x 0.03 19. Administrative cost allowance on expenditures of $5,500,000 or more (Field 17 x Field 18) 

### $



### ____________ 20. Add administrative cost allowance on expenditures less than $5,500,000 (($2.75 million x .05) + Field 12) + 

### $ 247,500 21. Total administrative cost allowance (Field 19 + Field 20) — go to Step 3 

### $



### ____________ **Step 3. Decide how much administrative cost allowance your school claimed.** 22. How much administrative cost allowance did your school claim? (The amount may be the same or less than the amount calculated in Step 2.) 

### $



### ____________ 23. How much administrative cost allowance did your school claim in each program? (a) Federal Perkins Loan (must be the same as Part III, Section B, Field 8) 

### $



### ____________ (b) FSEOG (must be the same as Part IV, Section D, Field 15) 

### $



### ____________ (c) FW S (must be the same as Part V, Section D, Field 15) 

### $



### ____________