Paul Douglas Teacher Scholarship Program Performance Report

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PAUL DOUGLAS TEACHER SCHOLARSHIP PROGRAM
PERFORMANCE REPORT FOR FY 2009
Reporting Period: July 1, 2008 - June 30, 2009
STATE ________________________
PLEASE READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM
Section I: Summary Repayment Information

Section II: Fulfillment of Scholarship Obligation

A. Number of Recipients as of June 30, 2009:

Number of Recipients as of 6/30/2009 who have
A. Completed the teacher
certification course of study:
B. Taught by grade level:
Public-A

1. In repayment status
2. In default status
3. In deferment status
4. Total - Cumulative

0

Private-B

1. Preschool level
2. Elementary level

B. Not in repayment status & not teaching:

3. Secondary level

1. Still pursuing course of study

4. Total - Cumulative

0

0

leading to teacher certification

C. Taught in teacher shortage area:

2. No longer pursuing teacher
certification course of study

1. Geographic

3. Certified to teach but not yet

2. Grade level

teaching (grace period)
4. Total - Cumulative

3. Subject matter
0

4. Total - Cumulative

0

C. Amount repaid during FY 2009:

D. Completed the Scholarship obligation:

1. Principal

1. By teaching

2. Interest
3. Total

2. By repaying the Scholarship
$0

3. By teaching & repayment
4. Total - Cumulative

0

D. Amount of principal as of 6/30/2009:
E. Had the Scholarship obligation
cancelled:

1. Total outstanding
2. In default status
3. In deferment status

Section III: Summary Outcomes for all Former Scholars

E. Amount of uncollectible debt written
off as of 6/30/2009:

A. Not in repayment status and not

1. Principal written-off

B. Teaching

0

2. Interest written-off

C. In repayment status

0

D. Completed or cancelled obligation

0

E. Total - Cumulative

0

3. Total - Cumulative
4. Number of Scholarships written-off

0

teaching

$0

Section IV: Certification by Authorized Official
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.

SIGNATURE

DATE

TYPED NAME/TITLE OF AUTHORIZED OFFICIAL
TELEPHONE NUMBER (AREA CODE) AND EXTENSION
FAX NUMBER (AREA CODE)

E-MAIL ADDRESS

NAME OF STATE AGENCY

ED Form Number(s): 40-31P, 84.176
STREET ADDRESS

OMB NUMBER: 1840-0787
STREET ADDRESS

Expiration Date: XX/XX/XXXX
CITY/STATE/ZIP CODE

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.