OMB Approval No. 1870-0503

United States Department of Education, Office for Civil Rights

ASSURANCE OF COMPLIANCE – CIVIL RIGHTS CERTIFICATE 

TITLE VI OF THE CIVIL RIGHTS ACT OF 1964, TITLE IX OF THE EDUCATION AMENDMENTS OF 1972,

SECTION 504 OF THE REHABILITATION ACT OF 1973, THE AGE DISCRIMINATION ACT OF 1975, AND 

THE BOY SCOUTS OF AMERICA EQUAL ACCESS ACT OF 2001

The applicant provides this assurance for the purpose of obtaining Federal grants, loans, contracts (except contracts of 

insurance or guaranty), property, discounts, funds made available through the U.S. Department of Education, or other Federal 

financial assistance from the Department. This assurance applies to all Federal financial assistance from or funds made 

available through the Department, including any that the applicant may seek in the future. 

The applicant assures that it will comply with: 

1. Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C. 2000d et seq., which prohibits discrimination on 

the basis of race, color, or national origin in any program or activity receiving Federal financial assistance. 

2. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits

discrimination on the basis of sex in any education program or activity receiving Federal financial assistance. 

3.Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on the 

basis of disability in any program or activity receiving Federal financial assistance. 

4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination on the 

basis of age in any program or activity receiving Federal financial assistance. 

5. If applicable, the Boy Scouts of America Equal Access Act of 2001, 20 U.S.C. 7905, which requires equal 

access for the Boy Scouts of America and other designated youth groups to meet at public schools. This law 

applies to any public elementary school, public secondary school, local educational agency, or State 

educational agency that has a designated open forum or limited public forum and that receives funds made 

available through the Department. 

6.All regulations, guidelines, and standards issued by the Department under any of these statutes. 

The applicant understands that it must comply with items 1-6 in order to continue receiving Federal financial assistance from 

the Department. The applicant also understands that this Assurance is binding on the applicant, its successors, transferees, 

and assignees at any time during which federal financial assistance is provided. The applicant will ensure that all contractors, 

subcontractors, subgrantees, or others with whom it arranges to provide services or benefits are not discriminating in violation 

of items 1-6. Otherwise, the financial assistance can be terminated and the applicant can be declared ineligible to receive 

further assistance. The applicant also understands that the Department may seek a court order requiring compliance with 

items 1-6 or seek other appropriate judicial relief. 

By signing this form, the applicant is agreeing to the above provisions.

Signature of Authorized Official Title 

Print Name Name of Institution or Agency

Date Street

PLEASE RETURN TO:

U.S. Department of Education

Office for Civil Rights

400 Maryland Avenue, SW

Washington, DC 20202-1100

City, State, Zip Code

Office Email Address

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 20 

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 retain benefit (42 U.S.C. 2000d et seq.; 20 U.S.C. 1681 et seq.; 29 U.S.C. 794; 42 U.S.C. 6101 et seq.; 20 U.S.C. 7905). 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 20202-4536 or email ICDocketMgr@ed.gov 

and reference the OMB Control Number 1870-0503. Note: Please do not return the completed Assurance of Compliance – Civil 

Rights Certificate to this address.