Eligible Population Data Request Form FY 2009

Grants to States for Workplace and Community Transition Training for Incarcerated Individuals Program

Eligible Population Data Request Form, FY2009

From the amount appropriated, the Secretary allots to each participating State/territory an amount that bears the same relationship to the amount appropriated as the total number of eligible students in each State bears to the total number of eligible students in all States. For the purpose of the formula, an "eligible student" means a male or female offender who has obtained a secondary school diploma or its equivalent and—

1. is incarcerated in a State prison, including a pre-release facility;

2. is eligible to be released or eligible for parole within seven years;

3. is 35 years of age or younger; and

4. has not been convicted of a “criminal offense against a victim who is a minor” or a “sexually violent offense” such as terms are defined in the Jacob Wetterling Crimes Against Children and Sexually Violent Offender Registration Act (42 U.S.C 14071 et seq.) or murder, as described in section 1111 of title 18, United States Code.

So that the Department can successfully implement the formula and allocate funds under this program, please complete the items below for April 1, 2009. If an April 1 count is not possible, please utilize the closest possible date’s count and indicate on this blank what that date is: ________________)

1. The number of individuals within your State/Territory who have obtained a secondary school diploma or its equivalent and are incarcerated in a State prison, including prerelease facilities: _______________________

2. Of those counted in number 1, how many are 35 or younger as of the date of your count: _______________________

3. Of those counted in number 2, how many are eligible for release or parole within 7 (seven) years of the date of your count: _______________________

4. Of those counted in number 3, how many have not been convicted of a “criminal offense against a victim who is a minor,” a “sexually violent offense,” or murder: _______________ (This is your official count.)

State or Territory Name: _________________________________

Person completing this form

Printed Name_______________________________ Signature__________________________

Title and Contact Information: ________________________________________________________________________________________________________________________________________________________

Please fax the completed form, no later than April 24, 2009 to Mr. John Linton at 202-245-7170 or email to: [email protected]. In addition, please forward a hard copy with original signature for certification purposes to: Mr. John Linton, Director of Correctional Education, Office of Vocational and Adult Education, U.S. Department of Education, 400 Maryland Avenue SW, Washington, DC 20202-7240.

Questions: [email protected] or 202-245-6592; [email protected] or 202-245-6187

Paperwork Burden Statement

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 1830-0563. The time required to complete this information collection is estimated to average 10 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: Office of Vocational and Adult Education, U.S. Department of Education, 400 Maryland Avenue, S.W., Washington, D.C. 20202.