| PAUL DOUGLAS TEACHER SCHOLARSHIP PROGRAM |
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| PERFORMANCE REPORT FOR FY 2009 |
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| Reporting Period: July 1, 2008 - June 30, 2009 |
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| STATE ________________________ |
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| PLEASE READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM |
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| Section I: Summary Repayment Information |
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Section II: Fulfillment of Scholarship Obligation |
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| A. Number of Recipients as of June 30, 2009: |
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Number of Recipients as of 6/30/2009 who have |
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| 1. |
In repayment status |
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A. Completed the teacher |
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| 2. |
In default status |
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certification course of study: |
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| 3. |
In deferment status |
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B. Taught by grade level: |
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Public-A |
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Private-B |
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| 4. |
Total - Cumulative |
0 |
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1. |
Preschool level |
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2. |
Elementary level |
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| B. Not in repayment status & not teaching: |
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3. |
Secondary level |
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| 1. |
Still pursuing course of study |
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4. |
Total - Cumulative |
0 |
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0 |
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leading to teacher certification |
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| 2. |
No longer pursuing teacher |
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C. Taught in teacher shortage area: |
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certification course of study |
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1. |
Geographic |
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| 3. |
Certified to teach but not yet |
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2. |
Grade level |
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teaching (grace period) |
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3. |
Subject matter |
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| 4. |
Total - Cumulative |
0 |
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4. |
Total - Cumulative |
0 |
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| C. Amount repaid during FY 2009: |
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D. Completed the Scholarship obligation: |
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| 1. |
Principal |
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1. |
By teaching |
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| 2. |
Interest |
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2. |
By repaying the Scholarship |
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| 3. |
Total |
$0 |
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3. |
By teaching & repayment |
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4. |
Total - Cumulative |
0 |
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| D. Amount of principal as of 6/30/2009: |
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| 1. |
Total outstanding |
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E. Had the Scholarship obligation |
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| 2. |
In default status |
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cancelled: |
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| 3. |
In deferment status |
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Section III: Summary Outcomes for all Former Scholars |
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| E. |
Amount of uncollectible debt written |
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A. |
Not in repayment status and not |
0 |
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off as of 6/30/2009: |
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teaching |
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| 1. |
Principal written-off |
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B. |
Teaching |
0 |
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| 2. |
Interest written-off |
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C. |
In repayment status |
0 |
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| 3. |
Total - Cumulative |
$0 |
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D. |
Completed or cancelled obligation |
0 |
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| 4. |
Number of Scholarships written-off |
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E. |
Total - Cumulative |
0 |
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| Section IV: Certification by Authorized Official |
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| I certify that the information provided in this Performance Report is based upon information reflected in the official accounting and program records of this agency. Upon request, such records will be made available to the Secretary or his delegate for review. |
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| SIGNATURE |
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DATE |
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| TYPED NAME/TITLE OF AUTHORIZED OFFICIAL |
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| TELEPHONE NUMBER (AREA CODE) AND EXTENSION |
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| FAX NUMBER (AREA CODE) |
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E-MAIL ADDRESS |
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| NAME OF STATE AGENCY |
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ED Form Number(s): 40-31P, 84.176 |
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| STREET ADDRESS |
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|
OMB NUMBER: 1840-0787 |
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| STREET ADDRESS |
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Expiration Date: XX/XX/XXXX |
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| CITY/STATE/ZIP CODE |
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| 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. The valid OMB control number for this information collection is 1840-0787. The time required to complete this information collection is estimated to average 12 hours per 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, D.C. 20202-4651. If you have comments or concerns regarding the status of your individual submission of this form, write directly to the Paul Douglas program officer at the address below. |
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