Form 109-234 Pre Application for Hurricane Education Recovery Awards

HURRICANE EDUCATION RECOVERY AWARDS

PRE-APPLICATION INFORMATION

IHE seeking an award: ____________________________________________________

Location: State: ___________________ County: _____________________________

Legal Address: ___________________________________________________________

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Contact person: Name _____________________________________________________

Title _____________________________________________________

Telephone _________________________________________________

Email ____________________________________________________

Briefly describe the extent of the hurricanes' impact on your institution: to what extent was it forced to close, relocate or significantly curtail its activities as a result of damage directly caused by the hurricanes? ____________________________________________

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The amount of each Higher Education Recovery Award will be determined by a formula including the elements noted below and the number of Pell Grant recipients enrolled at the institution in FY 2005 (all references to fiscal years (FY) in this document refer to the applicant institution's fiscal years). This formula will be used to allocate an equitable proportion of available funds to each impacted institution. This application does not constitute a “claim” for a certain amount of funds.

Please fill in the following figures, rounding each to the nearest $1000:

1. Tuition and fees revenue lost by this institution as a result of hurricanes in the Gulf of Mexico in calendar year 2005: $__________________

For the purposes of the Hurricane Education Recovery Awards, "tuition and fees revenue lost" is defined as the decrease in net tuition and fees revenue in FY 2006 compared to the institution’s FY 2005 financial statements. The tuition and fees category includes all tuition and fees (net of refunds, bad debt estimates, and any discounts recognized) assessed for educational purposes. This is consistent with the definition used by the IPEDS Finance survey.

2. Expenses already incurred by the institution in remediation of the effects of hurricanes: $______________________

For the purposes of these awards, "expenses already incurred" is defined as expenses paid or accrued in FY 2006 as a direct consequence of the 2005 hurricanes. For example, you may include such expenses as cost of evacuation, temporary lodgings, clean up, alternative facilities and operations, equipment repair and replacement, unusual personnel costs, etc.

3. Estimated construction costs to repair or replace campus buildings damaged by the hurricanes: $_______________________________

For the purposes of these awards, "estimated construction costs" is defined as costs incurred, or reasonably expected to be incurred in the future, to repair or replace facilities damaged by a hurricane in 2005, as calculated for a third party such as the Federal Emergency Management Administration, the state, or insurance claims. Do not include any expenses included in #2 above.

4. Please estimate how much of the expenses described in lines 1-3 above will be or has been reimbursed by insurance or other Federal agency, foundation or charitable outlays for hurricane relief? $ _________________

For the purposes of these awards, "will be or has been reimbursed" is defined as payments received or expected to be received under a property, business continuity, or other applicable insurance policy or self-insurance arrangement, grants or other payments from Federal agencies, foundations, or charities intended to offset expenses or losses due to hurricane damages.

Note: Each applicant is required to retain the original documents supporting the information supplied here for the purpose of any future audits. Do not send those documents as part of your application for an award.

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The signature of the institution's chief executive officer attesting to the accuracy of these figures is required below:

CEO's name: ________________________________________________________

CEO's signature: ______________________________________ Date: __________