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INSTRUCTIONS FOR COMPLETING THE ANNUAL PERFORMANCE, FINANCIAL 

NEED AND CERTIFICATION REPORT FOR THE JACOB K. JAVITS FELLOWSHIP 

PROGRAM

Section I: General Grantee Institution Information

Please be sure to complete one form for each cohort of Jacob K. Javits Fellows 

attending your institution. The Department of Education tracks funds for 

Jacob K. Javits Fellows according to the fiscal year in which they were initially

awarded a Jacob K. Javits Fellowship. All fellows initially awarded a fellowship 

in a particular fiscal year constitute a cohort. Thus, you must complete one form 

for each fiscal year listing all fellows in that particular cohort. 

Determine the level of financial need of each Jacob K. Javits Fellow on the 

enclosed list before completing these forms. Each Jacob K. Javits Fellow's 

demonstrated level of financial need must be reflected on these forms. 

Financial need is determined each year on the basis of the requirements for 

need analysis prescribed by Part F of Title IV of the Higher Education Act of 1965, 

as amended (HEA), except that tuition and fees are excluded from the student's 

cost of attendance. Tuition and fees are excluded because the fellowship 

includes an institutional payment that is provided in lieu of tuition and fees 

normally charged to the student. Your institution's financial aid office may be 

able to provide you with this information or assistance in calculating financial

need.

Continuing fellows must complete a Free Application for Federal Student Aid 

(FAFSA) immediately and submit the results to your institution for financial need 

determination. The FAFSA is available on the Internet at www.fafsa.ed.gov. 

Students may also obtain a hardcopy format in the financial aid office at your 

institution. 

Grant Number: Enter the ten-digit grant number that always begins with “P170B.”

There is a separate grant number for each cohort (group) of Jacob K. Javits 

fellows. Remember that a cohort includes all fellows initially awarded a 

fellowship in a particular fiscal year. Insert the number from the column entitled 

"PR#" on your grant award notification document or on the enclosed list of 

continuing fellows (if any). The first two digits after the B indicate the fiscal year 

of the initial award. For example, P170B010001 is the number for a fellow initially

awarded in fiscal year 2001. This number remains the same throughout the 
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period of a student's fellowship. In some documents, you may see a 2-digit 

suffix, for example, -99. Ignore the suffix for purposes of completing this form. The 

suffix indicates the current fiscal year.

Grantee Institution Name: Self-explanatory.

Grantee Institution Address: Self-explanatory.

Project Director: Please indicate the name of the person at the institution whom 

the Department of Education should contact regarding the administration of 

Javits Fellowships. The Javits Program Office also frequently refers to this 

individual as the “Javits Coordinator.”

Project Director Telephone Number: Self-explanatory.

Project Director Fax Number: Self-explanatory.

Project Director E-Mail Address: Self-explanatory.

Total Number of Javits Fellows in this cohort: List the total number of all fellows 

initially awarded a fellowship in the fiscal year referenced in this report. 

Section II: Individual Student Data

Name of Fellow: List the fellow to whom the grant number in Section I applies for 

this report. A list of fellows at your institution is provided. Enter the last name first, 

followed by the first name. 

NOTE: Never change a fellow from one cohort year (and the accompanying 

ten-digit grant number) to another.

Please enter “0” for any fellow who failed to submit his or her financial aid forms in 

time for you to calculate his or her financial need. 

Field of Study: List the field of study under which the fellow was awarded a 

Javits fellowship.

Year and Term student entered institution’s graduate program: Self-explanatory. 

Current Educational Status of the Fellow: Please indicate the status of the fellow
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on the report form for the current budget period as follows: "Currently Enrolled

Fellow,” "Graduated,” “Transferred to Name of Institution,” “On Interruption of 

Study,” “Funding Discontinued Due to Failure to Make Substantial Academic

Progress,” “Withdrawn Due to Non-Academic Reasons," or "Completed Tenure

But Still Enrolled.”

Fellow Financial Need and Certification Information for the Budget Period from 

 to : This is the next scheduled budget

period for which you must report financial need and certification information in 

order to request continuation funding for each fellow. Specifically, the dates for 

the next scheduled budget period are September 1, through August 

31, .

Months of Study: Enter the number of months of study projected for the fellow 

(maximum 12 months) during the budget period covered by this report. The 

fellowship can be calculated on a nine-month schedule if the student will not

be enrolled during the summer semester.

Total Financial Need: Enter the fellow's total financial need, as determined under

Part F of Title IV. 

Total Financial Need = Cost of Graduate Attendance - Student’s Estimated 

Family Contribution - Tuition & Fees. 

Note: If the student's financial need is zero, he or she is not eligible for any part 

of the Javits Fellowship.

Stipend Request: Enter the stipend request for each fellow. The stipend request 

should equal the fellow's financial need and/or the maximum stipend amount 

for the fiscal year, whichever is less.

Institutional Allowance: If the fellow will be enrolled for the full academic year 

(12-month period including the fall, spring and summer), enter the institutional

payment amount. If the fellow will attend less than a full academic year, enter 

a pro rata reduced amount.

Note: The fellowship provides an institutional allowance that is in lieu of all tuition 

and fees normally charged to the student for the period of enrollment. The 

allowance must be reduced by any amount collected by the institution from a 

fellow for tuition and other expenses related to the fellow's educational program 

(34 CFR 650.41).
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Prior-Year Stipend: Enter the stipend for which this fellow was determined to be 

eligible to receive in the previous year for this cohort. 

Unused Funds (if any): Enter any funding provided for the fellow that your 

institution did not use from the stipend, institutional allowance, or both for one of 

the reasons listed below. For any “Other” reason that applies, please provide a 

brief explanation in the space provided.

 If a student took a leave of absence after you submitted last year's report; 

(Note: An Interruption of Study is not allowed in the first year of the fellowship.)

 If a student withdrew or graduated after you submitted last year's report; or

 If a student transferred to another institution after you submitted last year's report.

 Other 

Required Certifications: These constitute all of the certifications which are 

required to establish the eligibility of each Javits fellow to receive continuation 

funding for the next scheduled budget period. These certifications also ensure 

the compliance of the grantee institution requesting continuation funding on 

behalf of the fellow for the budget period.

Methodology Certification: Certify that the fellow's financial need was 

calculated using the same manner as that in which the institution calculates all 

other graduate students' financial need under Part F of Title IV of the HEA by 

entering “Yes.”

Academic Progress Certification: Certify whether the fellow is making substantial

progress in his or her academic program by entering “Yes” or “No.” If “No,” 

provide a brief explanation in the space provided.

“Full-Time” Certification: Certify that the fellow will be devoting their full time to 

his or her academic program, as required, by entering “Yes.” 

Part-Time Employment Certification: Certify that each fellow will not be 

engaged in gainful employment (other than on a part-time basis as specified 

below) during the budget period by entering “Yes.” 

Note: A fellow may work part time, but only for the institution he or she attends, 

and only in teaching, research, or similar activity approved by the Secretary. 
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Leave Certification: Certify whether a fellow will be on an approved Interruption 

of Study for all or part of the award year by indicating the number of months in 

the space provided. If the fellow will not be on Interruption of Study, check “Not 

on Interruption of Study.” 

Note: The legislation for the Javits program permits an institution to 

allow a fellowship recipient an Interruption of Study for a period not 

to exceed 12 months for the purpose of work, travel, or independent 

study away from the campus if the independent study is supportive 

of the fellowship recipient's academic program. In the case of other 

exceptional circumstances, such as active duty military service or 

personal or family member illness, the institution of higher education 

may also permit the fellowship recipient to interrupt periods of study 

for the duration of the tour of duty (in the case of military service) or 

for not more than 12 months (in any other case), but without 

payment of the stipend. A fellow on an Interruption of Study does 

not receive financial support during the period of his or her leave, 

unless the leave is for the purpose of travel supportive of the fellow's 

academic program or independent study supportive of the fellow's 

academic program. In the space provided, please provide a brief 

explanation if you believe the fellow is entitled to support under these 

conditions.
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Section III: Agreement Certification (required by 34 CFR 650.40) for the 

Jacob K. Javits Fellowship Program: Upon completion of electronic report, the 

applicant, who is the grantee institution, must agree that it will comply with the 

amended statute (Title VII, Part A of the Higher Education Act of 1965) and 

regulations (34 CFR Part 650) in implementing the Jacob K. Javits Fellowship 

Program. Also, an authorized official must review all data entered and provide a 

signature certification that the Annual Performance, Financial Need and 

Certification Report is accurate and complete. 

Disclosure of 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 XX minutes/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 

mandatory (citing authority)/required to obtain or retain benefit (citing authority) and voluntary. 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 XXXXXXXX. Note: Please do not return the completed XXXX (cite form or other applicable reporting mechanism) 

application to this address.