OMB Number: 4040-0004

Expiration Date: 8/31/2016

Application for Federal Assistance SF-424

Preapplication

Application

* 2. Type of Application: * If Revision, select appropriate letter(s):

New

Continuation * Other (Specify):

Changed/Corrected Application Revision

* 3. Date Received: 4. Applicant Identifier:

5a. FederalEntity Identifier: 5b. Federal Award Identifier:

State Use Only:

6. Date Received by State: 7. StateApplication Identifier:

8. APPLICANT INFORMATION:

* a. Legal Name:

* b.Employer/TaxpayerIdentification Number(EIN/TIN): * c. Organizational DUNS:

d. Address:

* Street1:

Street2:

* City:

County/Parish:

* State:

Province:

* Country:

* Zip / Postal Code:

e. Organizational Unit:

DepartmentName: DivisionName:

f. Name and contact information of person to be contacted on matters involving this application:

Prefix: * First Name:

MiddleName:

* Last Name:

Suffix:

Title:

Organizational Affiliation:

* TelephoneNumber: Fax Number:

* Email:

* 1. Type of Submission:

USA: UNITED STATES
Application for Federal Assistance SF-424

* 9. Type of Applicant 1: Select Applicant Type:

Type of Applicant 2: Select Applicant Type:

Type of Applicant 3: Select Applicant Type:

* Other (specify):

* 10. Name of Federal Agency:

11. Catalog of Federal Domestic Assistance Number:

CFDA Title:

* 12. Funding Opportunity Number:

* Title:

13. Competition Identification Number:

Title:

14. Areas Affected by Project (Cities, Counties, States, etc.):

* 15. Descriptive Title of Applicant's Project:

Attach supporting documents as specified in agency instructions.

Add Attachment Delete Attachment View Attachment

Add Attachments Delete Attachments View Attachments
Application for Federal Assistance SF-424

16. Congressional Districts Of:

* a. Applicant

Attach an additional list of Program/Project Congressional Districts if needed.

* b.Program/Project

17. Proposed Project:

* a. Start Date: * b. End Date:

18. Estimated Funding ($):

* a. Federal

* b. Applicant

* c. State

* d. Local

* e. Other

* f. Program Income

* g. TOTAL

* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?

a. This application was made available to the State under the Executive Order 12372 Process for review on .

b. Program is subject to E.O. 12372 but has not been selected by the State for review.

c. Program is not covered by E.O. 12372.

* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.)

Yes No

If "Yes", provide explanation and attach

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21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements

herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to

comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may

subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)

** I AGREE

** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency

specificinstructions.

Authorized Representative:

Prefix: * First Name:

Middle Name:

* Last Name:

Suffix:

* Title:

* TelephoneNumber:

* Email:

FaxNumber:

* SignatureofAuthorizedRepresentative: * Date Signed:

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U.S. Department of Education

Supplemental Information for the SF-424

1. Project Director:

Prefix: * First Name: Middle Name: * Last Name: Suffix:

Address:

* Street1:

Street2:

* City:

County:

* State: * Zip Code: Country:

* Phone Number (give area code): Fax Number (give area code):

* Email Address:

2. Novice Applicant:

Are you are a novice applicant as defined in the regulations in 34 CFR 75.225 (and included in the

definitions page in the attached instructions)?

Yes No

3. Human Subjects Research:

a. Are any research activities involving human subjects planned at any time during the

proposed Project Period?

Yes No

b. Are ALL the research activities proposed designated to be exempt from the regulations?

Yes Provide Exemption(s) # (s): 1 2 3 4 5 6

No Provide Assurance #(s), if available:

c. If applicable, please attach your “Exempt Research” or “Nonexempt Research” narrative to this form

as indicated in the definitions page in the attached instructions.

OMB Number: 1894-0007

Expiration Date: 8/31/2017
U.S. DEPARTMENT OF EDUCATION 

BUDGET INFORMATION

NON-CONSTRUCTION PROGRAMS

OMB Control Number: 1894-0008

Expiration Date: 06/30/2017

Name of Institution/Organization Applicants requesting funding for only one year should complete the column under 

"Project Year 1." Applicants requesting funding for multi-year grants should complete all 

applicable columns. Please read all instructions before completing form.

SECTION A - BUDGET SUMMARY

U.S. DEPARTMENT OF EDUCATIO N FUNDS

Budget Categories Project Year 1 

(a)

Project Year 2 

(b)

Project Year 3 

(c)

Project Year 4 

(d)

Project Year 5 

(e)

Total

(f)

1. Personnel

2. Fringe Benefits

3. Travel

4. Equipment

5. Supplies

6. Contractual

7. Construction

8. Other

9. Total Direct Costs (lines 1-8)

10. Indirect Costs*

11. Training Stipends

12. Total Costs (lines 9-11)

*Indirect Cost Information (To Be Completed by Your Business Office):

If you are requesting reimbursement for indirect costs on line 10, please answer the following questions:

(1) Do you have an Indirect Cost Rate Agreement approved by the Federal government? ____Yes ____ No

(2) If yes, please provide the following information:

Period Covered by the Indirect Cost Rate Agreement: From: ___/___/___ _ To: ___/___/___ _ (mm/dd/yyyy)

Approving Federal agency: ____ ED ____ Other (please specify): _________ _ _ _ _ _ The Indirect Cost Rate is ___ ______% 

(3) For Restricted Rate Programs (check one) -- Are you using a restricted indirect cost rate that:

___ Is included in your approved Indirect Cost Rate Agreement? or ___ Complies with 34 CFR 76.564(c)(2)? The Restricted In direct Cost Rate is _________%

ED 524
Name of Institution/Organization Applicants requesting funding for only one year should complete the column under 

"Project Year 1." Applicants requesting funding for multi-year grants should complete all 

applicable columns. Please read all instructions before completing form.

SECTION B - BUDGET SUMMARY 

NON-FEDERAL FUNDS

Budget Categories

Project Year 1 

(a)

Project Year 2 

(b)

Project Year 3 

(c)

Project Year 4 

(d)

Project Year 5 

(e)

Total

(f)

1. Personnel

2. Fringe Benefits

3. Travel

4. Equipment

5. Supplies

6. Contractual

7. Construction

8. Other

9. Total Direct Costs

(Lines 1-8)

10. Indirect Costs

11. Training Stipends

12. Total Costs

(Lines 9-11)

SECTION C – BUDGET NARRATIVE (see instructions)

ED 524

., Washington, D.C. 20202.
OMB Control No. 1894-0005 (Exp. 03/31/2017)

NOTICE TO ALL APPLICANTS

The purpose of this enclosure is to inform you about

a new provision in the Department of Education's

General Education Provisions Act (GEPA) that

applies to applicants for new grant awards under

Department programs. This provision is Section 427

of GEPA, enacted as part of the Improving America's

Schools Act of 1994 (Public Law (P.L.) 103-382).

To Whom Does This Provision Apply?

Section 427 of GEPA affects applicants for new grant

awards under this program. ALL APPLICANTS

FOR NEW AWARDS MUST INCLUDE

INFORMATION IN THEIR APPLICATIONS

TO ADDRESS THIS NEW PROVISION IN

ORDER TO RECEIVE FUNDING UNDER THIS

PROGRAM.

(If this program is a State-formula grant program, a

State needs to provide this description only for

projects or activities that it carries out with funds

reserved for State-level uses. In addition, local

school districts or other eligible applicants that apply

to the State for funding need to provide this

description in their applications to the State for

funding. The State would be responsible for ensuring

that the school district or other local entity has

submitted a sufficient section 427 statement as

described below.)

What Does This Provision Require?

Section 427 requires each applicant for funds (other

than an individual person) to include in its

application a description of the steps the applicant

proposes to take to ensure equitable access to, and

participation in, its Federally-assisted program for

students, teachers, and other program beneficiaries

with special needs. This provision allows applicants

discretion in developing the required description.

The statute highlights six types of barriers that can

impede equitable access or participation: gender,

race, national origin, color, disability, or age. Based

on local circumstances, you should determine

whether these or other barriers may prevent your

students, teachers, etc. from such access or

participation in, the Federally-funded project or

activity. The description in your application of steps

to be taken to overcome these barriers need not be

lengthy; you may provide a clear and succinct

description of how you plan to address those barriers

that are applicable to your circumstances. In

addition, the information may be provided in a single

narrative, or, if appropriate, may be discussed in

connection with related topics in the application.

Section 427 is not intended to duplicate the

requirements of civil rights statutes, but rather to

ensure that, in designing their projects, applicants for

Federal funds address equity concerns that may affect

the ability of certain potential beneficiaries to fully

participate in the project and to achieve to high

standards. Consistent with program requirements and

its approved application, an applicant may use the

Federal funds awarded to it to eliminate barriers it

identifies.

What are Examples of How an Applicant Might

Satisfy the Requirement of This Provision?

The following examples may help illustrate how an

applicant may comply with Section 427.

(1) An applicant that proposes to carry out an

adult literacy project serving, among others,

adults with limited English proficiency, might

describe in its application how it intends to

distribute a brochure about the proposed project

to such potential participants in their native

language.

(2) An applicant that proposes to develop

instructional materials for classroom use might

describe how it will make the materials available

on audio tape or in braille for students who are

blind.

(3) An applicant that proposes to carry out a

model science program for secondary students

and is concerned that girls may be less likely

than boys to enroll in the course, might indicate

how it intends to conduct "outreach" efforts to

girls, to encourage their enrollment.

(4) An applicant that proposes a project to

increase school safety might describe the special

efforts it will take to address concern of lesbian,

gay, bisexual, and transgender students, and

efforts to reach out to and involve the families of

LGBT students

We recognize that many applicants may already be

implementing effective steps to ensure equity of

access and participation in their grant programs, and

we appreciate your cooperation in responding to the

requirements of this provision.

Estimated Burden Statement for GEPA Requirements

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 1.5 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 (Public Law 103-382. 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

1894-0005.
ASSURANCES - NON-CONSTRUCTION PROGRAMS

OMB Approval No. 0348-0040

NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the

awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such

is the case, you will be notified.

As the duly authorized representative of the applicant, I certify that the applicant:

1. Has the legal authority to apply for Federal assistance

and the institutional, managerial and financial capability

(including funds sufficient to pay the non-Federal share

of project cost) to ensure proper planning, management

and completion of the project described in this

application.

2. Will give the awarding agency, the Comptroller General

of the United States and, if appropriate, the State,

through any authorized representative, access to and

the right to examine all records, books, papers, or

documents related to the award; and will establish a

proper accounting system in accordance with generally

accepted accounting standards or agency directives.

3. Will establish safeguards to prohibit employees from

using their positions for a purpose that constitutes or

presents the appearance of personal or organizational

conflict of interest, or personal gain.

4. Will initiate and complete the work within the applicable

time frame after receipt of approval of the awarding

agency.

5. Will comply with the Intergovernmental Personnel Act of

1970 (42 U.S.C. §§4728-4763) relating to prescribed

standards for merit systems for programs funded under

one of the 19 statutes or regulations specified in

Appendix A of OPM's Standards for a Merit System of

Personnel Administration (5 C.F.R. 900, Subpart F).

6. Will comply with all Federal statutes relating to

nondiscrimination. These include but are not limited to:

(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)

which prohibits discrimination on the basis of race, color

or national origin; (b) Title IX of the Education

Amendments of 1972, as amended (20 U.S.C. §§1681-

1683, and 1685-1686), which prohibits discrimination on

the basis of sex; (c) Section 504 of the Rehabilitation

Act of 1973, as amended (29 U.S.C. §794), which

prohibits discrimination on the basis of handicaps; (d)

the Age Discrimination Act of 1975, as amended (42

U.S.C. §§6101-6107), which prohibits discrimination

on the basis of age; (e) the Drug Abuse Office and

Treatment Act of 1972 (P.L. 92-255), as amended,

relating to nondiscrimination on the basis of drug

abuse; (f) the Comprehensive Alcohol Abuse and

Alcoholism Prevention, Treatment and Rehabilitation

Act of 1970 (P.L. 91-616), as amended, relating to

nondiscrimination on the basis of alcohol abuse or

alcoholism; (g) §§523 and 527 of the Public Health

Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee

3), as amended, relating to confidentiality of alcohol

and drug abuse patient records; (h) Title VIII of the

Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as

amended, relating to nondiscrimination in the sale,

rental or financing of housing; (i) any other

nondiscrimination provisions in the specific statute(s)

under which application for Federal assistance is being

made; and, (j) the requirements of any other

nondiscrimination statute(s) which may apply to the

application.

7. Will comply, or has already complied, with the

requirements of Titles II and III of the Uniform

Relocation Assistance and Real Property Acquisition

Policies Act of 1970 (P.L. 91-646) which provide for

fair and equitable treatment of persons displaced or

whose property is acquired as a result of Federal or

federally-assisted programs. These requirements apply

to all interests in real property acquired for project

purposes regardless of Federal participation in

purchases.

8. Will comply, as applicable, with provisions of the

Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328)

which limit the political activities of employees whose

principal employment activities are funded in whole or

in part with Federal funds.

Previous Edition Usable Standard Form 424B (Rev. 7-97)

Authorized for Local Reproduction Prescribed by OMB Circular A-102

Public reporting burden for this collection of information is estimated to average 15 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. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for

reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. 

SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
9.

10.

11.

Will comply, as applicable, with the provisions of the DavisBacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act

(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract

Work Hours and Safety Standards Act (40 U.S.C. §§327-

333), regarding labor standards for federally-assisted

construction subagreements.

Will comply, if applicable, with flood insurance purchase

requirements of Section 102(a) of the Flood Disaster

Protection Act of 1973 (P.L. 93-234) which requires

recipients in a special flood hazard area to participate in the

program and to purchase flood insurance if the total cost of

insurable construction and acquisition is $10,000 or more.

Will comply with environmental standards which may be

prescribed pursuant to the following: (a) institution of

environmental quality control measures under the National

Environmental Policy Act of 1969 (P.L. 91-190) and

Executive Order (EO) 11514; (b) notification of violating

facilities pursuant to EO 11738; (c) protection of wetlands

pursuant to EO 11990; (d) evaluation of flood hazards in

floodplains in accordance with EO 11988; (e) assurance of

project consistency with the approved State management

program developed under the Coastal Zone Management

Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of

Federal actions to State (Clean Air) Implementation Plans

under Section 176(c) of the Clean Air Act of 1955, as

amended (42 U.S.C. §§7401 et seq.); (g) protection of

underground sources of drinking water under the Safe

Drinking Water Act of 1974, as amended (P.L. 93-523);

and, (h) protection of endangered species under the

Endangered Species Act of 1973, as amended (P.L. 93-

205).

12.

13.

14.

15.

16.

17.

18.

Will comply with the Wild and Scenic Rivers Act of

1968 (16 U.S.C. §§1271 et seq.) related to protecting

components or potential components of the national

wild and scenic rivers system.

Will assist the awarding agency in assuring compliance

with Section 106 of the National Historic Preservation

Act of 1966, as amended (16 U.S.C. §470), EO 11593

(identification and protection of historic properties), and

the Archaeological and Historic Preservation Act of

1974 (16 U.S.C. §§469a-1 et seq.).

Will comply with P.L. 93-348 regarding the protection of

human subjects involved in research, development, and

related activities supported by this award of assistance.

Will comply with the Laboratory Animal Welfare Act of

1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et

seq.) pertaining to the care, handling, and treatment of

warm blooded animals held for research, teaching, or

other activities supported by this award of assistance.

Will comply with the Lead-Based Paint Poisoning

Prevention Act (42 U.S.C. §§4801 et seq.) which

prohibits the use of lead-based paint in construction or

rehabilitation of residence structures.

Will cause to be performed the required financial and

compliance audits in accordance with the Single Audit

Act Amendments of 1996 and OMB Circular No. A-133,

"Audits of States, Local Governments, and Non-Profit

Organizations."

Will comply with all applicable requirements of all other

Federal laws, executive orders, regulations, and policies

governing this program.

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE

APPLICANT ORGANIZATION DATE SUBMITTED

Standard Form 424B (Rev. 7-97) Back
CERTIFICATION REGARDING LOBBYING

Certification for Contracts, Grants, Loans, and Cooperative Agreements

The undersigned certifies, to the best of his or her knowledge and belief, that:

(1) 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 an agency, a Member of Congress, an officer or employee of Congress, or an

employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the

making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment,

or modification of any Federal contract, grant, loan, or cooperative agreement.

(2) 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 agency, a Member of Congress, an officer or employee of Congress, or an employee of a

Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall

complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all

tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients

shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when

this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this

transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a

civil penalty of not less than $10,00 0 and not more than $100,000 for each such failure.

Statement for Loan Guarantees and Loan Insurance

The undersigned states, to the best of his or her knowledge and belief, that:

If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any

agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with

this commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and submit Standard

Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with its instructions. Submission of this statement is a prerequisite for

making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required

statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

* APPLICANT'S ORGANIZATION

* PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE

Prefix: * First Name: Middle Name:

* Last Name: Suffix:

* Title:

* SIGNATURE: * DATE:
_________ _________

______________

_____________

_______________________

DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046

(See reverse for public burden disclosure.)

1. Type of Federal Action:

a. contract

b. grant

c. cooperative agreement

d. loan

e. loan guarantee

f. loan insurance

2. Status of Federal Action:

a. bid/offer/application

b. initial award

c. post-award

3. Report Type:

a. initial filing

b. material change

For Material Change Only:

year quarter

date of last report

4. Name and Address of Reporting Entity:

Prime Subawardee

Tier , if known :

Congressional District, if known :

4c

5. If Reporting Entity in No. 4 is a Subawardee, Enter Name 

and Address of Prime:

Congressional District, if known :

6. Federal Department/Agency: 7. Federal Program Name/Description:

CFDA Number, if applicable:

8. Federal Action Number, if known : 9. Award Amount, if known :

$

10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if

(if individual, last name, first name, MI): different from No. 10a) 

(last name, first name, MI):

11. Information requested through this form is authorized by title 31 U.S.C. section 

1352. This disclosure of lobbying activities is a material representation of fact

upon which reliance was placed by the tier above when this transaction was made 

or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This 

information will be available for public inspection. Any person who fails to file the 

required disclosure shall be subject to a civil penalty of not less than $10,000 and 

not more than $100,000 for each such failure.

Signature:

Print Name: 

Title:

Telephone No.: Date: 

Federal Use Only: Authorized for Local Reproduction

Standard Form LLL (Rev. 7-97)

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