### U.S. DEPARTMENT OF EDUCATION **Washington, DC 20202**



## Fiscal Year **2014 Application Package to Request**  **Designation as an Eligible Institution Under the Following Title III and Title V Programs:** 

 Strengthening Institutions Program (SIP)  Alaska Native and Native Hawaiian
- Serving Institutions (ANNH) Program  Developing Hispanic
- Serving Institutions (HSI) Program  Hispanic Serving
- Institutions (STEM and Articulation) Program  Promoting Post
- baccalaureate Opportunities for Hispanic Americans (PPOHA)  Asian American and Native American Pacific Islander
- Serving (AANAPISI) Program  Predominantly

Black Institutions (PBI) Program  Waiver of the Non
- Federal Cost
- Share Requirement **CLOSING DATES: [Insert Date]**  **for Eligibility Designation**

**and Non**  **- Federal**  **Cost -**  **Share Waiver CFDA Number: 84.031H**  **OMB Number: 1840 -**  **xxxx , ED FORM 1049** 

**EXPIRES: [insert date]** 

# TABLE OF CONTENTS

**Dear Applicant Letter 1**  **Eligibility Highlights 4**  **Before You Get Started 5**  **Instructions for Completing the Application**  **Part I Identity of Applicant Institution**  **8 Part II**  **Institutional Enrollment 10**  **Part III Institutional Statistics**  **11 Part IV**  **Specific Institutional Eligibility 14** 

**Requirements Part V**  **Certification 23** 



# APPENDICES **Application For Designation As An Eligible Institution 25**  **(ED Form 1049) Federal**  **Register Closing Date Notice Inviting**  **28 Applications** 1

Dear Applicant: We are pleased to provide the application package for fiscal ye ar (FY) 201 4 Designation as an Eligible Institution under the following Title III and Title V programs of the Higher Education Act of 1965, as amended.

 STRENGTHENING INSTI TUTIONS PROGRAM (SIP)

 ALASKA NATIVE AND NATIVE HAWAIIAN
- SERVI NG INSTITUTIONS (ANNH) PROGRAM

 DEVELOPING HI SPANIC
- SERVING INSTITUTIONS (HSI) PROGRAM

 HI SPAN IC
- SERVING INSTI TUTIONS STEM and ARTI CULATION PROGRAM

 PROMOTI

NG POSTBACCALAUREATE OPPORTUNITIES FOR HI SPANI C AMERI CANS (PPOHA)

 ASIAN AMERICAN AND NATIVE AMERICAN PACIFIC ISLANDER
SERVI NG INSTITUT IO NS (AANAPISI) PROGRAM

 PREDOMI

NANTLY BLACK INSTITUTIONS ( PBI) PROGRAM This application package includes the information and instructions that you need to appl y for eligibility

designation. Eligibility

designation qualifies an institution of higher education (IHE) to appl y for grants under the above Title III and Title V programs, provided the institution meets certain additional program specific eligibility requirements. The purpose of these programs is to provide funds to eligible institutions of higher education to increase their self
- sufficiency

by improvin g their academic programs, institutional management, and fiscal stability
. In addition, this application package may be used by

IHEs to appl y for a waiver of certain non - Federal cost
- share requirements under the following programs:

 FEDERAL WORK
- STUDY (FWS) PROGRAM

 FEDERAL SUPPLEMENTAL EDUCATIONAL OPPORTUNI TY GRANTS (FSEOG) PROGRAM

 TRI O STUDENT SUPPORT SERVI CES (SSS) PROGRAM

 UNDERGRADUATE INTERNATIONAL STUDIES AND FOREIGN LANGUAGE (UISFL) PROGRAM2

Read this package in its entirety before you begin t o complete the application. Itis essential that you provide sufficient responses to ALL applicable questions and that you enter the correct data throughout the application.
.
 All institutions interested in applying for a new FY 201 4 Title III or Title V grant and/or the non
- Federal Cost
- Share Waiver **MUST** apply for eligibility designation b y **[insert date]**
.
 You must reappl y for eligibility each ye ar that yo u wish to apply for a new grant award. Even if Title III or Title V grants in subsequent fiscal ye ars are made by funding down the slate from an FY 2014 competition, an institution would still need to be deemed eligible in that fiscal year in order to receive that award.

 IH Es currentl y receiving Title III or Title V funds do not need to appl y for el igibility designation unless they

intend to appl y for a new grant. IH Es designated as Historically Black C olleges and Universities or Triball y Controlled Colleges and Universities are statutoril y exempt from the non
- Federal cost
- share match requirement an d do not need to appl y for eligibility designation.

 FY 201 4 applicants will report their required student head count figures based solely on their **201 1**  **fall semester** enrollment.

 To further assist you in determining the low
- income levels of your students, we have included (in the Federal Register notice) the **201 1**  low
- income figures, as determined b y the U.S. Census Bureau
. The term “low income individual” means an individual from a family whose taxable income for the preceding ye ar did not exceed 150 percent of an amount equal to the poverty level established by

the U.S. Census Bureau.

 To assist you with calculating your institution’s **average educational and general (E&G)**  **expenditures** per Full Time Equivalent (FTE) student, the ED Form 1049 has been improved to calculate your institution’s E&G expenditures for you. See page 1 3 for specific instructions.

 If you are designated as an eligible institution, your waiver of the non
- Federal cost - share requirement is effective for five consecutive years. You will need to request another waiver in **[insert date]**
.
 If you are a current Title III or Title V grant re cipient, you are already entitled to the cost
- share waiver. For FY 201 4 , all applications must be submitted electronicall y as described in this application package. The deadline is **[insert date]**
.3

Once you have submitted your eligibility application on line , please print a copy of your submissions for your records. If you need further assistance, please contact us at the telephone numbers or e
- mail addresses cited in this application package. Sincerel y, Leonard L. Hay

nes, III , Ph.D
. Senior Director Institutional Service4 

### ELIGIBILITY HIGHLIGHTS

 Please notify

the eligibility

staff if your institution’s legal name has changed. This **MUST** be done in writing prior to appl yi ng for eligibility designation. The eligibility staff’s contact information can be found on p age 5.

 You must apply

for eligibility

in your institution’s legal name. Also, if you are planning to submit an application for new funds, both applications (i.e., the eligibility application **a nd**  the application for funding) **MUST** be in the same name or your application for funding will be rejected.

 To apply

for a waiver of the non
- federal cost share requirement, you **MUST** apply for eligibility
.
 The term “low income individual” means an individual from a famil y whose taxable income for the preceding ye ar did not exceed 150 percent of an amount equal to the poverty level established by the U.S. Census Bureau
.
 Y ou have the option to select which program(s) you are appl yi ng to for Designation as an Eligible Institution.

 Once you submit your eligibility application, the sy stem will determine your status. I f deemed ineligible, the sy stem will then provide you with the following prompt: “Do you want to apply for a waiver?” Click “YES” and then upload yo ur waiver narrative. It is the applicant’s responsibility to upload ALL supporting documentation at the time of submission.

 You are responsible for verifying and certifying the accuracy and completeness of the data you submit. We are unable to notify institutions of errors or missing data.

 You must click **SUBMIT** to officially upload yo ur application. For your convenience, a **SAVE** button has been added to the submission page.

 Applicants can print their eligibility letters from the eligibility website at: http://opeweb.ed.gov/title3and5/
. The eligibility homepage list the dat es that letters can be printed.

 The Department will not mail letters to eligible applicants
. In eligible applicants may print their letters from the eligibility Web site.

 Applications must be submitted by 11:59 p.m. Washington, DC time on the closing d ates with all supporting documentation.5 

### BEFORE YOU GET STARTED Read this entire application package, and collect the required data before you attempt to complete the application online. This application package may be obtained using the “eligibility” link, at the following Web site :

http://opeweb.ed.gov/title3and5/ For any questions regarding the Eligibility application, you may

contact the individuals listed below: Carnisia.Proctor@ed.gov or 202
- 502
- 7606 Roby n.Wood@ed.gov or 202
- 502
- 7434 Jeffrey .Hartman@ed.gov or 202
- 502
- 7607 You will need your institution's unique 8
- digit identifier, referred to as the Office of Postsecondary

Education I dentification (OPE ID) number, in order to electronically retrieve and complete a valid eligibility application form
. If your institution’s OPE ID number is not readil y available, your business office or student financial aid offi ce should have your OPE ID number **.** Throughout this application package we refer to certain sections of program regulations
. In the event that you wish to reference the regulations governing the Title III and Title V programs, yo u may

do so at the follow ing Web site: http://www.ed.gov/legislation/FedRegister/finrule/2001
- 4/121599a.html Only individual accredited institutions, including eligible branch campuses, may app ly for designation as an eligible institution. The regulations at 34 CFR Part 606.2(a)(6) and 607.2(a)(4) outline the accreditation requirements. A higher education sy stem, foundation or district may not appl y on behalf of individual institutions. On ly s ubmit data pertinent to your individual institutio n. Do not include data that is reported as part of a single filing b y a higher education system or district no matter whether your institution normally maintains and submits data to the U. S. Department of Education as part of a single filing b y a higher education system for all institutions within that sy stem or b y a district for all institutions within that district. **Designation As An Eligible Branch Campus** To be designated as an eligible branch campus , the branch campus must meet the needy student enrollment requirement, the educational and general (E&G) expenditures requirement, and the definition of a branch campus. The regulations at 34 CFR Part 606.7(b) and 34 CFR Part 607.7(e) define “branc h campus ” as a unit of a college or university that is geographically

apart from the main campus and independent of that main campus. We consider a unit of a college or university to be independent of the main6

campus if the unit is permanent in nature ; of fers courses for credit and programs leading to an associate or bachelor’s degree ; is autonomous to the extent that it has its own faculty and administrative or supervisory organization ; and its own budgetary and hiring authority
. If your institution is a pplying for eligibility

as a branch campus, provide the eligibility data pertinent to the branch campus. The Government Paperwork Elimination Act (GPEA) of 1998 (P. L. 105
- 277) and the Federal Financial Assistance Management Improvement Act of 1999 (P. L. 106
- 107) encourage us to undertake initiatives to improve our grant processes. Enhancing the ability of individuals and entities to conduct business with us electronically is a major part of our response to these Acts. Therefore, we are taking steps to adopt the i nternet as our chief means of conducting transactions in order to improve services to our customers and to simplify

and expedite our business processes. Note : Some of the procedures for transmitting applications in these instructions differ from those in the Education Department General Administrative Regulations (EDGAR) (34 CFR 75.102). Under the Administrative Procedure Act (5 U.S.C. 553), the Department generally

offers interested parties the opportunity to comment on proposed regulations. However, these amendments make procedural changes onl y and do not establish new substantive policy . Therefore, under 5 U.S.C. 553(b)(A), the Secretary has determined that proposed rulemaking is not required. All applications and waiver narratives, must b e submitted electronicall y by **[insert date]**
. We are requiring that all FY 2014 applications for eligibility designation be su

bmitted electronically at : http://opeweb.ed.gov/title3and5/ You may submit your application in paper format if you are unable to submit an application electronicall y because :
 You do not have access to the i nternet ; or  You do not have the capacity to upload the data online
. Y ou must mail or fax a written statement to the Department, explaining which of the two grounds for an exception prevent you from using the i nternet to submit your application , n o later than two weeks before the application deadline (14 calendar day s or, if the fo urteenth calendar day

before the application deadline date falls on a Federal holiday , the next business day

following the Federal holiday), I f you mail your written statement to the Department, it must be postmarked no later than two weeks before the appl ication deadline date. If you fax your written statement to the Department, we must receive the faxed statement no later than two weeks before the application deadline. Address and mail or fax your statement to: Dr. Nancy Regan , U.S. Department of Education, 1990 K Street, N.W., Room 603 2 , Washington, DC 20006
- 8513. F ax : (202)7

502
- 7861 . Your paper application must be submitted in accordance with the mail or hand delivery instructions provided in the official notice published in the Federal Register
. **IMPORTANT NOTE:** Before submitting your application electronically , double check for accuracy

and print a copy

for yourself. When you press the submit button, the sy stem will display

a message confirming that you have successfull y submitted your applicati on. Save and print this confirmation as proof that you have submitted your application electronically . If you do not receive this confirmation, you should assume that we did not receive your application. Please contact Carnisia Proctor, Roby n Wood or Je ffrey Hartman (see p age 5 for contact information). You are responsible for verifying and certifying the accuracy and completeness of the data you submit. We are unable to notify institutions of errors or missing data. **Do not wait until the due date**  **to submit your application**  **:**
 **[Insert date]** for Eligibility Designation and the non
- Federal Cost
- Share Waiver8



## INSTRUCTIONS FOR COMPLETING THE **APPLICATION (ED Form 1049) (ELECTRONIC SUBMISSION REQUIRED)**  

## PART I
**– IDENTITY OF APPLICANT INSTITUTION** 
**ITEM 1. INSTITUTION/CAMPUS OPE ID NUMBER**  You will need your institution's unique 8
- digit identifier, referred to as the Office of Postsecondary

Education I dentification (OPE ID) number, in order to electronically retrieve and complete a valid eligibility applic ation form. **ITEM 2. NAME OF INSTITUTION/CAMPUS** Use your institution's complete name. If your institution is a branch campus, use the parent institution's name but follow it with the name of the branch campus (see definition of branch campus on page 5 o f the application package). For example, if you are referring to Brockport Campus, you would cite, “ State University of New York, Brockport Campus ”
. Enter the name of the institution in the spaces provided. If your institution's name has changed withi n the last two years, include the former name on the appropriate line provided in Part V of the eligibility application form. **ITEMS 3 THROUGH 6.** Self
- explanatory
. **ITEM 7. DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER Enter your institution’s DUNS num**  **ber in the spaces provided. DUNS Number**  : Dun and Bradstreet assign your institution's 9
- digit DUNS number. Your business office will likely know your institution’s DUNS number. If not, you can obtain it at no charge b y calling 1
- 800
- 333
- 0505 or by completing a DUNS Number Request Form. You may obtain the form at : http://www.dnb.com9

**ITEM 8. TYPE OF INSTITUTION** Enter your institution's type: **Identify the institution as either a 2 -** **year or 4 -** **year IHE**  **.** If your institution recently changed its status from 2
- ye ar to 4
- ye ar, identify the institution as 4
- year. If the institution offers both undergraduate and graduate education, identify it as a 4
- year institution. **ITEM 9. CONTROL OF INSTITUTION** Id entify the in stitution as either a private nonprofit institution or a public institution.10



## PART II **- INSTITUTIONAL ENROLLMENT**  **ITEM 1. TOTAL INSTITUTIONAL ENROLLMENT (Fall 2011**  **Head Count)** Determine the institution's **2011 fall semester**  head count of enrolled undergraduate and graduate students. Do not include foreign students who are not eligible to participate in Title IV need
- based financial assistance programs. Enter this number in the space provided. **ITEM 2. TOTAL MINORITY ENROLLMENT (Fall 2011**  **Head Count)** Determine the institution's **2011 fall semester**  head count of enrolled minority undergraduate and graduate students. Do not include foreign students who are not eligible to participate in Title IV need
- based financial assistance programs. The regulation s at 34 CFR Part 606.7(b) and Part 607.7(e) define minority student as a student who is Hispanic/Latino of any race, Alaska Native or American Indian, Asian American , Black or African American, Native Hawaiian or Other Pacific Islander
. Enter this number in the space provided.11



## PART III **- INSTITUTIONAL STATISTICS**  **ITEM 1. NEEDY STUDENT REQUIREMENT** Fill out Part III, Items 1A through 1D, using the following instructions. **ITEM 1.A. FALL 2011**  **HEAD COUNT ENROLLMENT OF UNDERGRADUATE AND**  **GRADUATEDEGREE STUDENTS** Determine the institution's total **2011 fall semester**  head count of undergraduate and graduate students who were enrolled in a **degree** program . The regulations at 34 CFR Part 606.7(b) and at 34 CFR Part 607.7(e) define “ degree student” as a student who enrolls at an institution for the purpose of obtaining a degree, certificate or other recognized educational credential offered b y that institution. We consider the transcript that a student receives for the successful comp letion of a two
- ye ar transfer program to be an “other recognized educational credential.” Do not include foreign students who are not eligible to participate in Title IV need
- based assistance programs. Determine the undergraduate student head count by in cluding all undergraduate students who were enrolled in a program that result ed in the award of a bachelor’s degree. In clude those enrolled in a two
- year transfer program and those enrolled in a two - year educational program that result ed in the award of an associate degree. Include those enrolled in a vocational or technical program of at least two years in length that result ed in the award of a certificate that testifies that the student qualifies to work as a technician or at the semip rofessional level in technological fields. Enter the total in the space provided under Part III, Item 1.A. **ITEM 1.B. FALL 2011**  **RECIPIENTS OF TITLE IV NEED -**  **BASED FINANCIAL ASSISTANCE**  Determine the institution's total **2011 fall semester**  **unduplicated** stu dent head count of degree students who received any of the following Title IV need
- based assistance: **Federal Pell Grant, Federal College Work Study, Federal Perkins Loan or Federal Supplemental**  **Educational Opportunity Grant.** To compute the unduplicated st udent head count, count each student who received Title IV need
- based assistance, regardless of the number of need
- based programs in which the student participated **. If a student participates in multiple need**  **- based programs, that student is to be counted**  **o nly**  **once .**  Enter the total in the space provided under item Part III, Item 1.B.12

**ITEM 1.C. FALL 2011**  **ENROLLMENT OF HALF TIME, UP TO AND INCLUDING FULL**  **- TIME, UNDERGRADUATE STUDENTS**  Determine the institution's total **2011 fall semester**  undergraduate head count of students who were enrolled at least **half time** in degree programs at your institution
. Do not include foreign students who are not eligible for Title IV need
- based financial assistance. Enter the total in the space provided under Part III, Ite m 1.C. **ITEM 1.D. FALL 2**  **011 PELL GRANT RECIPIENTS ONLY**  Determine your institution's total **2011 fall semester**  undergraduate head count of students who received **Pell Grants** for the **2011 -**  **2012** academic term. In clude Pell Grant recipients who were enrolled in a program on at least a half
- time basis. Enter the total undergraduate head count of Pell Grant recipients in the space provided under Part III, Item 1.D. **ITEM 2. EDUCATIONAL AND GENERAL (E& G) EXPENDITURES**  **REQUIREMENT** Use the following instructions to complete items 2.A through 2.D. **ITEM 2.A. UNDERGRADUATE FULL -**  **TIME EQUIVALENT, FALL 2011**  **ENROLLMENT** Determine your institution's full
- time equivalent (FTE) **2011 fall semester**  enrollment of undergraduate students. The regulations at 34 CFR Part 606.7(b) and 34 CFR Part 607.7(e) describe how to calculate your FTE enrollment and the instructions below paraphrase those regulations. Based on the full
- time load at your institution , count a full
- time undergraduate student as one FTE. Determine the FTE for part
- time undergraduate students by entering the total number of credit hours of all part
- time undergraduate students. The total will automatically be divided by

12. The result is the FTE for part
- time undergraduate students. The sy stem will then add the total (full
- time AND part - time) undergraduate students. The result is the total number of undergraduate FTE equivalent **FY 2011**  enrollment. **NOTE: This number should not exceed the total institutional enrollment entered**  **under Part II, Item 1. ITEM 2.B. GRADUATE FULL**  **- TIME EQUIVALENT**  **2011 FALL**  **ENROLLMENT**13

Determine the institution's FTE **2011 fall semester**  enrollment of graduate students, if any , including both full
- time and part
- time students, as explained here. Based on the full
- time load at your institution, count a full
- time graduate student as one FTE. Determine the FTE for part
- time graduate student s by entering the total number of credit hours of all part
- time graduate students. That number will automatically be divided by 12. The result is the FTE for part
- time graduate students. C alculate the total graduate FTE by adding the FTE of full
- time graduate students to the FTE of part
- time graduate students, then **multiply** this total by a factor of 2.5. This final figure is the graduate FTE. The use of the 2.5 factor is required b y the Department’s regulations at 34 CFR 606.4(a) (2) and 607.4(a) (2) t o account for higher educational and general expenditures for graduate versus undergraduate students. The sy stem will then add the total (full
- time plus part
- time) graduate students. The result is the total number of graduate FTE equivalent **FY 2011**  enrol lment. **ITEM 2.C. TOTAL EDUCATIONAL AND GENERAL EXPENDITURES** Determine the institution's E&G expenditures for **2011 -**  **2012** . The regulations at 34 CFR Part 606.7(b) and 34 CFR Part 607.7(e) define E&G expenditures as the **total amount** expended by

an IHE for: instruction, research, public service, academic support (including library

expenditures), student services, institutional support, scholarships and fellowships, operation and maintenance expenditures for phys ical plant, and any mandatory

transfers whi ch the institution is required to pay by law. In determining the institution's E&G expenditures, total these costs. **Do not include Federal student financial aid.**  Enter the total **2011 -**  **2012** E&G expenditures in the space provided under Part III, Item 2.C. **ITEM 2.D. AVERAGE EDUCATIONAL AND GENERAL EXPENDITURES PER FTE STUDENT**  The sy stem will calculate the institution's average E&G expenditures per FTE for **2011 -**  **2012**
.14



## PART IV. SPECIFIC INSTITUTIONAL E **LIGIBILITY**

**REQUIREMENTS ITEM 1. NEEDY STUDENT REQUIREMENTS**  Use the following calculations to determine whether your institution meets the needy student requirement in at least one of two possible way s. YOUR INSTITUT ION MEETS THE NEEDY STUDENT REQUIREMENT IF:

A. At least 50% of its **2011** fall semester, unduplicated student head count of undergraduate degree students received financial assistance under one or more of the following programs: Federal Pell Grant, Federal College Work
- Study, Federal Perkins L oan or Federal Supplemental Educational Opportunity

Grant Programs (Part III, 1B). Or B. The percentage of its **2011** fall semester, undergraduate degree students who were enrolled on at least a half
- time basis and received Federal Pell Grants exc eeded the median percentage of undergraduate degree students who were enrolled on at least a half
- time basis and received Federal Pell Grants at comparable institutions that offered similar instruction (Part III, 1D). **ITEM 1. A. AT LEAST 50% OR MORE OF FA LL**  **2011 DEGREE STUDENTS**  **WERE RECIPIENTS OF NEED -**  **BASED FINANCIAL SUPPORT**  If your institution **meets** the needy student requirement because **50 percent or more** of its **2011** fall semester enrolled degree students received the above
- mentioned Title IV need
- base d financial assistance, select Part IV, Item 1.A. **If the percentage turns out to be less than 50%,**  **DO NOT select Part IV, Item 1.A.** 15

**EXAMPLE: Needy Student Calculation**  To determine whether yo ur institution meets the statutory needy student requirement for **2011 -**  **2012** , divide the number of **2011** fall semester, Title IV recipients (Part III, Item 1.B) b y the **2011** fall semester enrollment of degree students (Part III, Item 1.A). The result (Part III, 1.B., divided b y Part III, 1.A) is the percentage of needy students enrolled in the institution for the base ye ar. If the result is 50 percent or more , your instituti on meets the statutory needy student requirement threshold. The regulations at 34 CFR Part 606.3(a)(1) and at 34 CFR Part 607.3(a)(1) describe the needy student requirement. **Example 2011**  fall semester enrollment (Part III, 1.A) = 800 degree students **2 011**  fall semester Title IV recipients (Part III, 1.B) = 600 students Percentage of recipients of need
- based financial support = 75% (600 divided by

800) The example institution meets the needy student requirement because 50 percent or more of its **2011** fall semester degree students received need
- based financial support
. **ITEM 1.B. THE PERCENTAGE OF FEDERAL PELL GRANT RECIPIENTS AT THE APPLICANT INSTITUTION**  **EXCEEDED THE MEDIAN PERCENTAGE AT SIMILAR INSTITUTIONS.**   If your institution **meets** the statutory needy student requirement because the percentage of its **2011** fall semester enrolled students that received Pell Grants exceeded the median Federal Pell Grant percentage for its category of institutions (see below), **check Pa**  **rt IV, Item 1.B.**  If your percentage **does not exceed** the median Federal Pell Grant percentage for your category of institutions, **do not check Part IV, Item**  **1.B. If the institution meets both Part IV, Items 1.A and 1.B,**  **check the box next to Part**  **IV, Item 1.A only.**16

**EXAMPLE: Needy Student Calculation**  To determine if your institution meets the statutory needy student requirement for **201 1**  , divide the number of **201 1**  fall semester Pell Grant recipients (Part III It em 1.D) b y the **201 1**  fall semester enrollment of half

- time up to and including full
- time degree seeking students (Part III Item 1.C). The result (Part III, 1.D, divided by Part III, 1.C) is the percentage of Pell Grant recipients enrolled in the institution for the base year. If this result **exceeds** the "Median Federal Pell Grant Percentage" for your category of institutions, your insti tution meets the statutory needy student requirement threshold. **Example 201**  **1** fall semester enrollment of half
- time to full
- time degree students (Part III, 1.C) = 600 **201 1**  fall semester Pell Grant recipients (Part III, 1.D) = 250) **201 1**  Pell Grant percentage = 41.6% (250 divided by 600) **Here are the median Federal Pell Grant percentages or thresholds for base year 2011**  **- 2012**  **:** For 2
- ye ar public institutions, the median = **37.6%** For 2
- ye ar non - profit private institutions, the median = **44.1%** For 4
- ye ar public institutions, the median = **35.4%** For 4
- ye ar non - profit private institutions, the median = **35.5 %**  Since in our example, the institution’s Pell Grant percentage is greater than the median Pell Grant percentage for any category of institution, the example institution meets the needy student requirement. **ITEM 1.C. REQUESTING A WAIVER OF THE NEEDY STUDENT REQUIREMENT**  

###  If the institution **does not meet** the statutory needy student requirement, **under either** the Title IV need
- based financial assistance 50% threshold **or** the appropriate Pell Grant threshold, you may

request a waiver of this requirement. **Before doing so, review**  **the seven possible**  **waiver options**  **below** . These options correspond to the seven options listed in the regulations at 34 CFR Part 606.3(b) and 34 CFR Part 607.3(b). Check Part IV, Item 1.C, denoting that you are requesting a waiver. After you review the seven possible waiver options for the needy student requirement, select the option(s) that applies to your institution’s particular situation . You may apply for more than one option
.17

**Prepare a separate narrative that**  **provid es**  **the required evidence for**  **the chosen waiver option(s)**  **and demonstrates that the**  **waiver(s) appl**  **ies to your particular**  **institution. Following the instructions detailed below, the**  **narrative must contain compelling evidence. Mere statements of fact may not be enough to support your**  **request. Provide supporting documentation (relevan t studies, recent reports and/or**  **data, etc.) to justify your request for a waiver. It is acceptable to upload photocopies of supporting documentation when addressing the waivers.**  **Needy Student Waiver Option #1 , 34 CFR 606.3(b)(1) and 607.3(b)(1)**  Provide evidence that the s tate provided **more than 30 percent** of your institution’s budget for the 2011
- 2012 base year . **AND** Provide evidence that your institution charged not more than $ 99.00 per student for tuition and fees for the 2011
- 2012 base ye ar. **Please identify the resources provided by the state, citing specific dollar amounts. Also, show actual tuition and fees charged per student, and provide supporting**  **documentation such as posted tuition and fees. Needy Student Waiver Option #2**  **, 34 CFR 60 6.3(b)(2) and 607.3(b)(2)**  Provide evidence that **at least 30 percent** of the students served b y your institution in the **2011 -**  **2012** base ye ar **were students from low -**  **income families.** The regulations at 34 CFR Part 606.7(c) and 34 CFR 607.7(e) define a low income individual to be one from a family whose taxable income for the base year did not exceed 150% of an amount equal to the poverty level as determined by

the U.S. Census Bureau
. In the Federal Register Closing Date Notice, we stated the low
- income figures for **2011**
. **Support your request by providing documentation (statistical and whole numbers baseline data) that verifies your claim that at least 30 percent of your enrolled students**  **were from low -** **income families. Needy Student Waiver**  **Option #3, 34 CFR 606.3(b)(3) and 607.3(b)(3)**  Provide evidence that your institution, in the base year, **substantially increased the higher education opportunities for low**  **- income students who were also educationally**  **disadvantaged, or from groups underrepresented in postsecondary education, or**  **were minority students** . The program regulations at 34 CFR 606.7(b) and 607.7(e) define " educationally disadvantaged ", " minority student” and " underrepresented "
. In clude **ALL** the following information:18 l. A description of the student body characteristics, including the racial/ethnic composition and the number of low
- income students, for the **2011 -**  **2012** base year. 2. The number of low
- income students for the **2011 -**  **2012** base ye ar that were also educationall y disadvantaged, fro m groups underrepresented in postsecondary education, or minority students. 3. A description of the programs and services in place during the **2011 -**  **2012** base ye ar that were specifically designed to increase the educational opportunities for the low income students who were also educationally disadvantaged, from groups underrepresented in higher education, or minority students. 4. A longitudinal progression detailing the number of these students served by the institution’s programs and services during the past five academic periods: **2007 -**  **2008 ,**  **2008 -**  **2009 ,**  **2009 -**  **2010 ,**  **2010 -**  **2011 and**  **2011 -**  **2012**
. **Needy Student Waiver Option #4, 34 CFR 606.3(b)(4) and 607.3(b)(4)**  Provide evidence that your institution substantially increased the higher education opportunities in the **2011 -**  **2012** base ye ar **for individuals who resided in an area that is not included in a "metropolitan statistical ar**  **ea** " (MSA) as defined b y the Office of Management and Budget and who were unserved by other postsecondary

institutions. In clude **ALL** the following information: 1. The geographical areas of residence for enrolled students in the **2011 -**  **2012** base year includi ng:

-- The percentage of enrolled students from MSAs; and

-- The percentage of enrolled students from locations outside an MSA. 2. A map or scale drawing showing the geographically isolated or rural nature of yo ur institution’s location. Include its ge ographic relationship to the nearest other institution(s) of higher education and nearest MSA; and the mileage between the institution and other institutions and the nearest MSA. 3. A description of the geographic barriers and climatic and other conditio ns that limit the options of individuals to attend other institutions. 4. A brief longitudinal progression detailing the number of enrolled students served b y the applicant institution during the past five academic periods: **2007 -**  **2008 ,**  **2008 -**  **2009 ,**  **2009 -**  **20 10**  **, 2010**  **- 2011**  **and 2011**  **- 2012**  who resided in areas outside the boundaries of an MSA.19

**Needy Student Waiver Option #5, 34 CFR 607.3(b)(5)**  Provide evidence that your institution is located **on or within 50 miles of an American Indian reservation or of a**  **substantial population of American Indians** , and that the institution will substantially increase higher education opportunities for American Indians. In addressing "higher education opportunities for American Indians;” include both student enrollment and retention. In clude **ALL** the following information: 1. A map or scale drawing showing your institution's location in relation to the American Indian reservation or population center. Include the mileage between the institution and the reservation or population center. 2. A description of the student body characteristics for the **2011 -**  **2012** base year and the two academic ye ars following the base ye ar **( 2012**  **- 2013**  and **2013 -**  **2014 )**  . Include the racial/ethnic composition and specificall y identify the number and percentage of American Indian students by full
- time and part
- time status. 3. Describe the programs and services in place during the **2011 -**  **2012** base year and the two academic ye ars following the base ye ar **( 2012**  **- 2013**  and **2013 -**  **2014 )**  that were specific ally

designed to increase the higher educational opportunities for American Indians. 4. Describe your institution's plans to develop and implement programs and services specificall y designed to increase the higher educational opportunities for American Indians. 5. Describe the institution's enrollment goals for American Indian students for the next three academic years **( 2011**  **- 2012**  **, 2012**  **- 2013**  and **2013 -**  **2014 )**  . Detail the institution's plans to meet these goals. **Needy Student Waiver Option #7 , 34**  **CFR 607.3(b)(7):** Provide evidence that your institution **will substantially increase higher education opportunities for Hispanic/Latino of any race, Alaska Native or American Indian,**  **Asian American**  **, Black or African American, Native Hawaiian or Other Pac ific**  **Islander, White, Two or More.** When addressing "higher education opportunities" include both student enrollment and retention. In clude **ALL** of the following information: 1. A description of the student body characteristics for the **2011 -**  **2012** bas e year and the two academic ye ars following the base ye ar **( 2012**  **- 2013**  and **2013 -**  **2014 )**  . Include the racial/ethnic composition and specificall y identify the number and the percentage for each racial/ethnic group listed above b y full
- time and part
- time status.20 2. Describe the programs and services in place during the **2011 -**  **2012** base year and the two academic ye ars following the base ye ar **( 2012**  **- 2013**  and **2013 -**  **2014 )**  that were specifically

designed to increase the higher educational opportunities for one or more of the racial/ethnic groups listed above. 3. Describe the programs and services your institution is currently developing that are specificall y designed to increase the higher educational opportunities for one or more of the racial/ethnic groups listed above. Include the projected date(s) for the implementation of these programs and serv ices. 4. Describe your institution's enrollment goals for one or more of the racial/ethnic groups listed above for the next three academic ye ars **( 2011**  **- 2012**  **, 2012**  **- 2013**  and **2013 -**  **2014 )**  . Explain in detail the institution's plans to meet these goals. **PART IV, ITEM 2. EDUCATIONAL & GENERAL EXPENDITURES**  **REQUIREMENT** Your institution meets the E&G expenditures requirement if its average E&G expenditures per FTE student cited in Part III, It em 2.D, is less than the average E& G per FTE for the same category of institution. **The average 2011**  **- 2012**  **E&G expenditures per FTE student for each category of institution is the following:**  **2 -**  **year public institution =**  **$ per FTE student**  **2 -**  **year non -**  **profit private =**  **$ per FTE student**  **4 -**  **y ear public institution**  **= $**  **per FTE student 4**  **- year non**  **- profit private**  **= $**  **per FTE student PART IV, ITEM 2.A**   Ch eck Item 2.A onl y if your institution’s **2011 -**  **2012** average E&G expenditures per FTE are less than the average E& G expenditures per FTE student for its category of institution. **PART IV, ITEM 2.B**  Ch eck Item 2.B if your institution ex ceeded the E&G expenditures threshold and you are requesting a waiver. Write a justification for each waiver option you are reques ting. 

### Instructions for Selecting Waiver Option(s) for the E&G Expenditures **Requirement** Review all six waiver options below and select the option(s) that applies to your institution’s situation
. You may request multiple options . You must submit a written j ustification with the eligibility application form for each option requested. The waiver21

option justification narrative must contain compelling evidence that the specific waiver condition exists. **Mere statements of fact may not be enough to support your r equest.**  **Provide supporting documentation (relevant studies, recent reports and/or data, etc.) to justify your request for a waiver. It is acceptable to upload photocopies of**  **supporting documentation when addressing the waivers. E&G Waiver Option #1,**  **34 CFR 606.4(d)(1) and 607.4(d)(1)**  **Low student enrollment** in the Fall **2011** distorted your institution’s E&G expenditures per FTE undergraduate student and the institution’s eligible designation is otherwise consistent with the purposes of the Title III or Title V program. Please show your institutions enrollment was low relative to the enrollment before the base year and/or low relative to the enrollment after the base ye ar. **Provide detailed evidence to**  **support your claim that low student enrollment in 2011**  **distort ed**  **your E&G expenditures. Show that enrollments in the years prior to and after**  **2011 were greater, citing specific numbers. Please include comparisons with**  **similar IHEs. E&G Waiver Option #2,**  **34 CFR 606.4(d)(2) and 607.4(d)(2)** Location of the institution in **an unusually high cost -**  **of -**  **living area** distorted your institution’s E&G expenditures per FTE undergraduate student and the institution’s eligible designation is otherwise consistent with the purposes of the Title III or Title V program. Provide documentation from a governmental source to substantiate the high cost of living in the area. **Cite recent statistics from local, state and/or national levels. Please include comparisons**  **with similar IHEs .**  **E&G Waiver Option #3 , 34 CFR 606.4(d)(3)**  **and 607.4(d)(3) High**  **energy costs** distorted your institution’s E&G expenditures per FTE undergraduate student and the institution’s eligible designation is otherwise consistent with the purposes of the Title III or Title V program. **Provide documentation to substantiate the high**  **energy costs.**  **Please show comparisons**  **with similar IHEs**  **and include supporting documentation. E&G Waiver Option #4,**  **34 CFR 606.4(d)(4) and 607.4(d)(4) An increase in State funding**  **, that was part of a desegregation**  **plan for higher**  **education ,**  distorted your institution’s E&G expenditures per FTE undergraduate student and the institution’s eligible designation is otherwise consistent with the purposes of the Title III or Title V program.22

**Provide documentation to substantiate your request.**  **E&G Waiver Option #5 , 34 CFR 606.4(d)(5) and 607.4(d)(5)**  **Operation of high cost professional schools** such as medical and dental schools or technology and health science programs, distorted your institution’s E&G expenditures per FTE undergraduate student, and the institution’s eligible designation is otherwise consistent with the purposes of the Title III or Title V program. **Provide documentation to substantiate your request. Please include enrollment and cost comparisons**  **with similar IHEs** **.**23 

## PART V. CERTIFICATION A duly authorized representative of the institution must check the box in Part V to certify that to the best of his or her knowledge that all data in the application are true and correct and that the applicant institution will comply with the required assurances. By checking this box and submitting this application, the applicant institution also certifies that they meet the accrediting requirements and, if applicable, meet the definition of a bra nch campus .24 

# APPENDICES

**Application for**  **Designation As An Eligible Institution (ED Form 1049)**  **Federal Register Closing Date Notice Inviting Applications**25 **UNITED ST AT**  **ES DEPA RTMENT OF EDUCA**  **TION WA** **SHINGTON, D.C. 20006 APPLICA** 

**TION FOR DESIGNA**

**TION A S A**  **N ELIGIBLE INSTITUTION**  **FISC AL**  **YEA R**  **20 14**  CFDA Number: **031H** To apply for grants under Title III Programs (SIP), (ANNH), (AANAPISI), Title V Programs (HSI - STEM and ARTICULATION), (PPOHA) and the Predominately Black Institutions (PBI) Programs Authority: 34 CFR Part 606 and 607 Programs **Important: You are required to provide the information requested**

**in order to obtain or retain a benefit.** According to the Paperwork R eduction Act of 1995, no persons are required to respond to a collection of information un less such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1840 - 0103. T he time required to complete this information collection is estimated to average 7.00 hours (or minutes) per response, i ncluding the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. I f you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving thi s form, please write to: U .S. Department of Education, Wa shington, D.C. 20202 - 4561. I f you have comments or concerns regarding the status of your individual submission for this form, write directly to: Institutional Services, U.S. Department of Educa tion, 1990 K Street, N.W., 6 th Floor ; Wa shington, DC 20 006 - 8513 *** This form must be completed electronically .**  **Part I. Identity of A pplicant Institution**  1. Institution/Campus OPE ID Number: 2. Name of Institution/Campus Requesting: 3. Address (Street # or P.O. Box and Street Name, City, State, Zip): 4. Contact Person’s Name: (Last Name, First Name, Middle Initial): 5. Contact Person’s Title, Phone Number, Extension: 6. E - ma il Address: 7. Data Universal Numbering System (DUNS Number): 8. T ype (m ark one): ( ) 2 - Year Institution ( ) 4 - Year Institution 9. Control (mark one): ( ) Private Non - Profit Institution ( ) Public Institution **Part II. Institutional Enrollment** 1. Total Institutional Enrollment (Fall 2011 Head Count): 2. To tal Minority Enrollment (Fall 2011 Head Count): **Part III. Institutional Statistics 1. Needy Student Requirement**  A. Fall 2011 Head Count Enrollment of Undergraduate and Graduate Degree Students:26 B. Fall 2011 Recipients of Title IV Need - Based Financial Assistance: (Include Only Pell Grant, Supplemental Educational Opportunity Grant, College Work Study, and Perkins Loan) C. Fall 2011 Enrollment of Half- Ti me up to and including Full - Time Undergraduate Students: D. Fall 201 1 Pell Grant Recipients: **2. Educational & General Expenditures Requirement (E&G)** A. Undergraduate Full - Time Equivalent Fall 2011 Enrollment a. Total Full - Time Undergraduate Students: b. Total Number of Credit Hours for all Part - Time Undergraduate Students: B. Graduate Full - Time Equivalent Fall 2011 Enrollment: a. Total Full - Time Graduate Students: b. Total Number of Credit Hours for all Part - Time Graduate Students: C. Total 2011 - 2012 Educational & General Expenditures (E&G): D. Average 2011 - 2012 E&G per FTE = C/(A+B):

**Part IV. Specific Institutional Eligibility Requirements 1. Needy Student Requirement (mark A**  **, B. or C)** ( ) A. According to the result, after dividing item 1B by item 1A in Part III of this form, at least 50% of Degree Students are recipients of Need - Based Financial Support; or ( ) B. According to the result, after dividing item 1D by item 1C in Part III of this form, our enrollment exceeds the pertinent threshold for Substantial Percentage of Students Receiving Pell Grants fo r the 2011 - 2012 ye ar. ( ) C. Requesting W aiver (Section 607.3(b) and Section 606.3(b) option(s): Ch eck an option, and attach the narrative justification to this form. **AN D**  **2. Educational & General Expenditures Requirement (mark A or B)**  ( ) A. The E& G expenditures per FTE Student are less than the pertinent threshold for base year 2011 - 2012
. ( ) B. Requesting Wa iver (Section 607.4(c) and (d) and Section 606.4(c) and (d) option(s): Ch eck an option, and attach the narrative justification to this form.27 **Part V. Certification** (Although this Certification requirement is waived for applicants applying online , the Department reserves the right to require a signed form on request.) To the best of m y knowledge and belief, all data in this application are true and correct. The governing body of the applicant has duly authorized this document and the applicant will comply with the required assurances. We m eet the accrediting requirements and, if applicable, we meet the definition of a branch campus as defi ned in 34 CFR Part 606.7(b) and 34 CFR 607.7(e). Authorized Representative's Typed Name and Title : Date : Authorized Representative's Signature : Phone Number : Fax Number : Form er Name of Applicant : Institution/Campus (if applicable) ” Form Approved - OMB No. 1840 - 0103 Expiration Date 03/31/2014 ED Form 1049 (Revised 11/99), Replaces ED Form 1049, Revised 8/95 which is obsolete. Page 2 of 2