Emergency Clearance of Homeless Education Disaster Assistance Application

APPLICATION FOR FUNDING

UNDER THE

HOMELESS EDUCATION DISASTER ASSISTANCE PROGRAM

CDFA Number: 84.383A

Form Approved:

OMB Number:

Expiration Date:

According to the Paperwork Reduction Act, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this information collection is xx hours per LEA response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202-4651. If you have any comments or concerns regarding the status of your individual submission of this form, please write directly to:

Zollie Stevenson, Jr., Ph.D., Director

Student Achievement and School Accountability Programs

U.S. Department of Education

400 Maryland Ave. SW

Washington, DC 20202-6132

GENERAL INSTRUCTIONS

Application Information

Each local educational agency (LEA) or LEA consortium seeking funding under the Homeless Education Disaster Assistance (HEDA) program must submit an electronic application to the U.S. Department of Education that includes the following information:

1. The completed HEDA application cover page;

2. The following assurances or certifications:

• Assurances for Non-Construction Programs (SF 424B Form)

• Certification Regarding Lobbying (ED 80-0013 Form);

3. A description of the LEA’s (or lead LEA in an LEA consortium) compliance with the equitable access and participation requirements in section 427 of the General Education Provisions Act; and

4. A completed HEDA Form A providing the number of enrolled students in kindergarten through grade twelve in your LEA or LEA consortium who became homeless as a result of a federally-declared natural disaster¹ that occurred in calendar year 2008 (2008) and the applicable disaster identification numbers. In Form A provide:

• the name of your LEA or, in the case of an LEA consortium, the designated lead LEA;

• your LEA’s (or, in the case of an LEA consortium, the designated lead LEA) Federal ID (NCES) number; and

• the requested counts of students in Column 5.

5. In the case of an LEA consortium, a completed HEDA Form B providing the number of enrolled students in kindergarten through grade twelve in all the LEAs that make up the consortium who became homeless as a result of a federally-declared natural disaster ¹ that occurred in calendar year 2008 (2008) and the applicable disaster identification numbers. In Form B provide:

• the name of each LEA in the LEA consortium;

• the Federal ID (NCES) number of each LEA in the LEA consortium; and

• the counts of homeless students enrolled.

NOTE: Only an LEA or a consortium of LEAs that had a total of at least fifty enrolled students in kindergarten through grade twelve who became homeless as a result of a federally-declared major disaster that occurred during 2008 is eligible for a grant under the HEDA program. (For consortia of LEAs, each LEA in the consortium does not need to have 50 or more students; the combined total reported by the consortium must be at least 50.)

Application Due Date:

HOMELESS EDUCATION DISASTER ASSISTANCE PROGRAM

APPLICATION COVER PAGE

1. Legal Name of Applicant Local Educational Agency (LEA)	DUNS Identification Number: Taxpayer Identification Number: Applicant LEA NCES ID Number:
5. Applicant LEA Address (including zip code)	6. Contact Person Name: Position: Telephone: Fax:
7. Is the applicant delinquent of any Federal debt? ___No	__Yes, explanation attached
8. Is the application for a consortium of LEAs? ___Yes ___No
9. If you answered “Yes” to Question 8, please list the legal names and NCES numbers for all participating LEAs in the consortium:
10. To the best of my knowledge and belief, all data are true and correct. The document has been duly authorized by the governing body of the applicant and the applicant will comply with the assurances provided in this package if the assistance is awarded.
.a. Typed Name and Title of Authorized Representative	b. Telephone Number
c. Signature of Authorized Representative:	d. Date

INSTRUCTIONS FOR APPLICATION COVER PAGE

1. Legal Name of LEA. Enter the legal name of the applicant local educational agency (LEA).

(For a consortium enter the legal name of the lead applicant LEA.)

2. D-U-N-S Number. Enter the applicant’s D-U-N-S Number. If your organization does not have a

D-U-N-S Number, you can obtain the number by calling 1-800-333-0505 or by completing a D-U-N-S Number Request Form. The form can be obtained via the Internet at the following URL: http://www.dnb.com

3. Taxpayer Identification Number. Enter the taxpayer’s identification number as assigned by the Internal Revenue Service. For a consortium enter only the lead LEA’s number.

4. LEA NCES ID Number: Enter the applicant’s NCES number. The NCES number can be obtained via the Internet at the following URL: http://nces.ed.gov/globallocator/

5. Address. Address of the applicant LEA, or in the case of a consortium the address of the lead LEA.

6. Program Contact. Name, address, telephone and fax numbers, and email address of the person to be contacted on matters involving this application.

7. Federal Debt Delinquency. Check “Yes” if the LEA is delinquent on any Federal debt. (This question refers to the applicant’s organization and not to the person who signs as the authorized representative. Categories of debt include delinquent audit disallowances, loans and taxes.) Otherwise, check “No.”

8. Consortium: Two or more LEAs who agree to apply for the grant and distribute the funds together while managing their individual responsibilities for maintaining auditable records for homeless student identification and allowable expenditures.

9. LEAs participating in a consortium: List the name and information for the lead LEA in #1-6 and then the legal name and NCES number for each of the other participating LEAs in this text box.

10. Certification. To be signed by the authorized LEA representative of the applicant LEA.

[INSERT SF 424B Form]

[INSERT ED 80-0013 Form]

[INSERT Instructions for GEPA 427 Description]

HEDA Form A - Number of Homeless Students and Natural Disaster Identifications¹

LEA (or, in the case of an LEA consortium, the lead LEA) Name:
Federal ID (NCES) Number:
1	For purposes of the HEDA program, a natural disaster is one for which the President declared a major disaster under title IV of the Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1974. For a list of specific counties in which there has been a Federally declared disaster in 2008 go to the Federal Emergency Management Agency's (FEMA) website at: http://www.fema.gov/news/disasters.fema?year=2008#sev1
Column (1) Disaster Number	Column (2) Natural Disaster	Column (3) Date of Disaster Declaration	Column (4) States with Counties in Which There Has Been a Natural Disaster	Column (5) Number of K-12 Students Enrolled in Your LEA(s) Made Homeless by a 2008 Natural Disaster Listed in Column (2)
1789	Hurricane Gustav	9/10/08	Alabama
1797	Severe Storms and Flooding associated with Hurricane Ike	9/26/08	Alabama
1796	Severe Storms, Flooding, Landslides, and Mudslides	9/26/08	Alaska
1744	Severe Storms, Tornadoes, and Flooding	2/7/08	Arkansas
1751	Severe Storms, Tornadoes, and Flooding	3/26/08	Arkansas
1758	Severe Storms, Flooding, and Tornadoes	5/20/08	Arkansas
1793	Severe Storms and Flooding associated with Hurricane Gustav	9/18/08	Arkansas
1762	Severe Storms and Tornadoes	5/26/08	Colorado
1785	Tropical Storm Fay	8/24/08	Florida
1750	Severe Storms and Tornadoes	3/20/08	Georgia
1761	Severe Storms and Flooding	5/23/08	Georgia
1743	Severe Storms, High Surf, Flooding, and Mudslides	2/6/08	Hawaii
1781	Flooding	7/31/08	Idaho
1747	Severe Storms and Flooding	3/7/08	Illinois
1771	Severe Storms and Flooding	6/24/08	Illinois
1800	Severe Storms and Flooding	10/3/08	Illinois
1740	Severe Storms and Flooding	1/30/08	Indiana
1766	Severe Storms and Flooding	6/8/08	Indiana
1795	Severe Storms and Flooding	9/23/08	Indiana
1737	Severe Winter Storm	1/4/08	Iowa
1763	Severe Storms, Tornadoes, and Flooding	5/27/08	Iowa
1741	Severe Winter Storms	2/1/08	Kansas
1776	Severe Storms, Flooding, and Tornadoes	7/9/08	Kansas
1746	Severe Storms, Tornadoes, Straight-line Winds, and Flooding	2/21/08	Kentucky
1757	Severe Storms, Tornadoes, Flooding, Mudslides, and Landslides	5/19/08	Kentucky
1802	Severe Wind Storm associated with Tropical Depression Ike	10/9/08	Kentucky
1786	Hurricane Gustav	9/2/08	Louisiana
Column (1) Disaster Number	Column (2) Natural Disaster	Column (3) Date of Disaster Declaration	Column (4) States with Counties in Which There Has Been a Natural Disaster	Column (5) Number of K-12 Students Enrolled in Your LEA(s) Made Homeless by a 2008 Natural Disaster Listed in Column (2)
1792	Hurricane Ike	9/13/08	Louisiana
1755	Severe Storms and Flooding	5/9/08	Maine
1788	Severe Storms, Flooding, and Tornadoes	9/9/08	Maine
1777	Severe Storms, Tornadoes, and Flooding	7/14/08	Michigan
1772	Severe Storms and Flooding	6/25/08	Minnesota
1753	Severe Storms and Flooding	5/8/08	Mississippi
1764	Severe Storms and Tornadoes	5/28/08	Mississippi
1794	Hurricane Gustav	9/22/08	Mississippi
1742	Severe Storms, Tornadoes, and Flooding	2/5/08	Missouri
1748	Severe Winter Storms and Flooding	3/12/08	Missouri
1749	Severe Storms and Flooding	3/19/08	Missouri
1760	Severe Storms and Tornadoes	5/23/08	Missouri
1773	Severe Storms and Flooding	6/25/08	Missouri
1767	Severe Winter Storm	6/13/08	Montana
1739	Severe Winter Storm	1/11/08	Nebraska
1765	Severe Storms, Tornadoes, and Flooding	5/30/08	Nebraska
1770	Severe Storms, Tornadoes, and Flooding	6/20/08	Nebraska
1779	Severe Storms, Straight-line winds, and Flooding	7/18/08	Nebraska
1738	Severe Winter Storms and Flooding	1/8/08	Nevada
1782	Severe Storms, Tornado, and Flooding	8/11/08	New Hampshire
1787	Severe Storms and Flooding	9/5/08	New Hampshire
1799	Severe Storms and Flooding	10/3/08	New Hampshire
1783	Severe Storms and Flooding	8/14/08	New Mexico
1801	Tropical Storm Hanna	10/8/08	North Carolina
1752	Severe Storms, Tornadoes, and Flooding	5/5/08	Oklahoma
1754	Severe Storms, Tornadoes, and Flooding	5/9/08	Oklahoma
1756	Severe Storms, Tornadoes, and Flooding	5/14/08	Oklahoma
1775	Severe Storms and Flooding	7/9/08	Oklahoma
1803	Severe Storms, Tornadoes, and Flooding	10/9/08	Oklahoma
1798	Severe Storms and Flooding	10/1/08	Puerto Rico
1759	Severe Winter Storm and Record and Near Record Snow	5/22/08	South Dakota
1774	Severe Storms and Flooding	7/9/08	South Dakota
1745	Severe Storms, Tornadoes, Straight-line Winds, and Flooding	2/7/08	Tennessee
1780	Hurricane Dolly	7/24/08	Texas
1791	Hurricane Ike	9/13/08	Texas
1778	Severe Storms and Flooding	7/15/08	Vermont
1784	Severe Storms, a Tornado, and Flooding	8/15/08	Vermont
1790	Severe Storms and Flooding	9/12/08	Vermont
1769	Severe Storms, Tornadoes, Flooding, Mudslides, and Landslides	6/19/08	West Virginia
Column (1) Disaster Number	Column (2) Natural Disaster	Column (3) Date of Disaster Declaration	Column (4) States with Counties in Which There Has Been a Natural Disaster	Column (5) Number of K-12 Students Enrolled in Your LEA(s) Made Homeless by a 2008 Natural Disaster Listed in Column (2)
1768	Severe Storms, Tornadoes, and Flooding	6/14/08	Wisconsin
	List of disasters is current as of November 20, 2008. Additional disasters for 2008 will be listed as they are declared.
	LEA/Consortium Total			ED system will auto-calculate the total

INSTRUCTIONS FOR HEDA FORM A

Number of Homeless Students and Natural Disaster Identifications

1. Enter in Column 5 the number of enrolled K-12 students made homeless by any of the federally-declared natural disasters in 2008 listed by the Federal Emergency Management Agency (FEMA). For additional information and for the most up-to-date list of federally-declared natural disasters in 2008 listed by FEMA, see http://www.fema.gov/news/disasters.fema#sev1.

2. An LEA should not count a student made homeless by a natural disaster in 2008 more than once. If a student was made homeless by more than one natural disaster, count the student for any one for which you have a verifiable and auditable record.

3. Only students who were enrolled by the LEA should be counted.

4. You do not need to enter “0” next to the natural disasters for which no homeless student identification or enrollment resulted.

5. Consortia should enter in Column 5 aggregate numbers for all participating LEAs.

6. The total is auto-calculated. Check that the total number of students whose homelessness is tied to one of these natural disasters is 50 or higher to be eligible for a grant award.

HEDA FORM B

Number of Homeless Students and Natural Disaster Identifications

(Required for Consortia Applicants Only)

Column (1)	Column (2)	Column (3)
Legal Name of each LEA in consortium	NCES Identification Number of each LEA in consortium	Number of K-12 Students in each LEA who were homeless as a result of a natural disaster that occurred in 2008

Will the lead LEA distribute funds under the HEDA program based on each LEA’s proportionate share of the total number of students made homeless by natural disasters?

YES

NO

If no, describe the alternate needs-based method for distributing funds among participating LEAs agreed upon in writing by all members of the LEA consortium

INSTRUCTIONS FOR HEDA FORM B (REQUIRED FOR CONSORTIA ONLY)

1. Enter in Column (1) the full legal name of every LEA participating in the consortium.

2. Enter in Column (2) the NCES number for each participating LEA.

3. Enter in Column (3), for each participating LEA, the total number of enrolled K-12 students who were made homeless by a 2008 natural disaster. These students must be included in HEDA Form A in the aggregate count of students for the consortia who were made homeless by the specific natural disasters listed in that form.

NOTES:

• It is the responsibility of both the lead LEA for the consortium and each participating LEA to have accurate data and auditable records on the numbers of homeless students enrolled who were made homeless by a natural disaster.

• The total number of students made homeless by a natural disaster who are enrolled in all the LEAs participating in the consortium must equal the total number reported on HEDA Form A, which aggregates the data for all participating LEAs.

1 For purposes of the HEDA program, a natural disaster is one for which the President declared a major disaster under Title IV of the Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1974.