OMB Number: 4040-0004

Expiration Date: 03/31/2012

Application for Federal Assistance SF-424 

*1. Type of Submission:

 Preapplication

 Application

 Changed/Corrected Application

*2. Type of Application:

 New

 Continuation

 Revision 

* If Revision, select appropriate letter(s):

 

*Other (Specify):

* 3. Date Received: 4. Applicant Identifier:

5a. Federal Entity Identifier: *5b. Federal Award Identifier:

State Use Only:

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

8. APPLICANT INFORMATION: 

*a. Legal Name: 

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

d. Address:

*Street 1:

 Street 2:

*City:

 County/Parish:

*State:

 Province:

*Country:

*Zip / Postal Code:

e. Organizational Unit:

Department Name: Division Name:

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

Prefix: *First Name: 

Middle Name:

*Last Name:

Suffix:

Title:

Organizational Affiliation:

*Telephone Number: Fax Number: 

*Email: 

Application for Federal Assistance SF-424 

Completed by Grants.gov upon submission
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:

Application for Federal Assistance SF-424

16. Congressional Districts Of:

*a. Applicant: *b. Program/Project: 

Attach supporting documents as specified in agency instructions.
Attach an additional list of Program/Project Congressional Districts if needed. 

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.

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 specific instructions.

Authorized Representative:

Prefix: *First Name: 

Middle Name:

*Last Name:

Suffix:

*Title: 

*Telephone Number: Fax Number: 

* Email: 

*Signature of Authorized Representative: *Date Signed: Completed by Grants.gov upon submission Completed by Grants.gov upon submission
SUPPLEMENTAL INFORMATION

REQUIRED FOR

DEPARTMENT OF EDUCATION

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. Applicant Experience:

 Novice Applicant Yes No Not applicable to this program

3. Human Subjects Research:

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

 proposed project Period?

 Yes No

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

 Yes Provide Exemption(s) #: 

 No Provide Assurance #, if available: 

Please attach an explanation Narrative:

Add Attachment Delete Attachment View Attachment
Standard Form 424B (Rev. 7-97) 

OMB Approval No. 0348-0040

ASSURANCES - NON-CONSTRUCTION PROGRAMS

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.

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 dd3 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 the 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.
9. 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.

10. 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.

 

11. 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 (Clear Air) Implementation Plans 

under Section 176(c) of the Clear 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 Will comply with the Wild and Scenic Rivers Act of 1968 

(16 U.S.C. 1721 et seq.) related to protecting components 

or potential components of the national wild and scenic rivers 

system.

13. 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.).

14. 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. 

15. 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.

16. 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.

17. 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.

18. Will comply with all applicable requirements of all other 

Federal laws, executive orders, regulations and policies 

governing this program

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

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE

APPLICANT ORGANIZATION DATE SUBMITTED
86

U.S. DEPARTMENT OF EDUCATION

BUDGET INFORMATION

NON-CONSTRUCTION PROGRAMS 

OMB Control Number: 1894-0008

Expiration Date: 02/28/2011

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 EDUCATION 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): __________________________

(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)?
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)
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 any 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 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, loam 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 

$10,000 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 or 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 of Authorized Representative Printed Title of Authorized Representative

Signature Date

ED 80-0013
 

Applicant’s (Organization) Name: ____________________________________________________________

Applicant’s DUNS Number: _________________________________________________________________

Federal Program: ________________________________________________CFDA Number: ___________ 

1. Has the applicant ever received a grant or contract 

from the Federal government?

Yes No

2. Is the applicant a faith-based organization? 

Yes No

3. Is the applicant a secular organization? 

Yes No

4. Does the applicant have 501(c)(3) status?

Yes No

5. Is the applicant a local affiliate of a national

organization? 

Yes No

6. How many full-time equivalent employees does the 

applicant have? (Check only one box).

3 or Fewer 15-50 

4-5 51-100

6-14 over 100

7. What is the size of the applicant’s annual budget? 

(Check only one box.)

Less Than $150,000

$150,000 - $299,999

$300,000 - $499,999

$500,000 - $999,999

$1,000,000 - $4,999,999

$5,000,000 or more

Purpose: The Federal government is committed to ensuring that all qualified applicants, small or large, non-religious 

or faith-based, have an equal opportunity to compete for Federal funding. In order for us to better understand the 

population of applicants for Federal funds, we are asking nonprofit private organizations (not including private 

universities) to fill out this survey. 

Upon receipt, the survey will be separated from the application. Information provided on the survey will not be 

considered in any way in making funding decisions and will not be included in the Federal grants database. While 

your help in this data collection process is greatly appreciated, completion of this survey is voluntary. 

Survey on Ensuring Equal Opportunity for Applicants

OMB No. 1890-0014 Exp. 05/31/2012
Approved by OMB

0348-0046

Disclosure of Lobbying Activities

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

(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: 

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

and Address of Prime: 

 Congressional District, if known: 

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

CFDA Number, if applicable: __________________

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

$ 

10. a. Name and Address of Lobbying Registrant

 (if individual, last name, first name, MI): 

b. Individuals Performing Services (including address if 

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 reported to the Congress semi-annually and 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)