HBCU Masters Application

U.S. DEPARTMENT OF EDUCATION

OFFICE OF POSTSECONDARY EDUCATION

WASHINGTON, DC 20006-8521

Fiscal Year XXXX

APPLICATION FOR GRANTS

HISTORICALLY BLACK COLLEGES AND UNIVERSITIES MASTERS DEGREE PROGRAM

CFDA Nos. 84.382G

CLOSING DATE: [insert date]

OMB No. 1840-New

Exp. XX/XX/XXXX

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 1840-XXXX. The time required to complete this information collection is estimated to average X hours (or minutes) 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. 20202-4537.

If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Gary Thomas, Office of Postsecondary Education, U.S. Department of Education, 1990 K St., NW, 6^th floor, Washington D.C. 20006-8521.

TABLE OF CONTENTS

Dear Applicant Letter……………………………………………………………………..1

Competition Highlights…………………………….……………………...………………2

Overview of Programs………………………………….…………………………………3

Requirements and Funding Rules…………………………………………………………4

Statute……………………………………………………………………………………..8Instructions for Completing the Application

Part I: Project Plan………………………………………………………………………12

Profile Form and Program Assurances………………………………………………..14

Goals and Objectives Form……………………………………………………...…….16

Part II: Formula Elements……………………………………………………………….17

Part III: Standard Forms, Certifications and Surveys……………………………………19

Application for Federal Assistance (SF 424)………………………………………….20

Instructions for the SF 424…………………………………………………………….24

Supplemental Information Required for Department of Education…………………...26

Instructions for Supplement to SF 424………………………………………………..27

Definitions for Supplement to SF 424………………………………………………...28

ED 524 Budget Information…………………………………………………………..31

Instructions for ED 524……………………………………………………………….33

GEPA………………………………………………………………………………….35

Disclosure of Lobbying Activities SF-LLL…………………………………………...36

Instructions for Completion of SF-LLL…………………………………………….…37

GPRA………………………………………………………………………………….38

Survey on Ensuring Equal Opportunity for Applicants……………………………….40

Executive Order 12372: Intergovernmental Review………………………………….42

Application Transmittal Instructions………………………………………………….43

Application Checklist………………………………………………………………….44

U.S. DEPARTMENT OF EDUCATION

OFFICE OF POSTSECONDARY EDUCATION

WASHINGTON, DC 20006-8521

Dear Applicant:

Thank you for your interest in applying for a grant in fiscal year (FY) XXXX for new awards under the Historically Black Colleges and Universities (HBCU) Masters Degree Program. Funding for this program is provided under Title VIII, Part AA, Section 897 of the Higher Education Act of 1965, as amended (HEA). Section 897 authorizes and appropriates mandatory funding for activities to be carried out under Title VII, Subpart 4, Section 723 of the HEA, for grant awards to eligible institutions making a substantial contribution to graduate education opportunities at the masters degree level in the following areas: mathematics; engineering; the physical or natural sciences; computer science; information technology; nursing; allied health; or other scientific disciplines in which African Americans are underrepresented. The program provides grants for up to six years to establish or strengthen qualified masters degree programs in these fields.

Institutions of higher education eligible to apply for and receive grants under the HBCU Masters Degree Program are designated in the statute. A copy of the statute for this program and all instructions and forms necessary to apply for grants are included in this application booklet.

Technical Assistance workshops will be held to help eligible institutions design applications that meet the requirements of the program and conform to the policies of the U.S. Department of Education.

If you have any questions or require additional information, please contact Gary Thomas via mail at: [email protected] or by phone at (202) 502-7767.

I appreciate your interest in the HBCU Masters Degree Programs and look forward to receiving your application.

Sincerely,

Vickie L. Schray

Acting Deputy Assistant Secretary

for Higher Education Programs

Office of Postsecondary Education

Competition Highlights

1. Each eligible institution specified in Section 723 of the HEA will receive a grant of no less than $500,000 for any fiscal year, unless the amount appropriated is not sufficient to pay the minimum grant awards to all eligible institutions; in this event, the amount paid to each eligible institution will be ratably reduced.

2. Any amount appropriated for these programs during any fiscal year in excess of $9,000,000 shall be made available to each of the eligible institutions pursuant to a formula developed by the Secretary that uses the following elements:

   • The ability of the institution to match Federal funds with non-Federal funds;

   • The number of students enrolled in the qualified masters degree program at the eligible institution in the previous academic year;

   • The average cost of attendance per student, for all full-time students enrolled in the qualified masters degree program at the institution;

   • The number of students in the previous year who received a degree in the qualified masters degree program at each institution; and

   • The contribution, on a percent basis, of the programs for which the institution is eligible to receive funds under this program to the total number of African Americans receiving masters degrees in the disciplines related to the programs for the previous year.

3. If a grant in excess of $1,000,000 is made to any institution in a given fiscal year, that institution must provide assurances that 50 percent of the costs of the activities supported by the grant that exceed the $1,000,000 limit will be paid from non-Federal funds. No institution will be required to match any portion of the first $1,000,000 of that institution’s grant award for a fiscal year.

4. Eligible institutions must complete the Goals Objectives Form, the Profile Form and Program Assurances, and the Formula Data in addition to the standard ED Forms and narrative portions of the application.

5. Eligible institutions must submit annually data relating to the programs’ formula elements, regardless of that fiscal year’s appropriation for these programs.

6. The consolidated application package must be mailed to the Application Control Center by [insert date]. Application transmittal instructions are provided on page 44 of this application package.

7. Applications will be reviewed by program staff to ensure accuracy, consistency and compliance with the program statute and applicable regulations. Institutions may be requested to make changes to their applications before funds will be awarded.

HISTORICALLY BLACK COLLEGES AND UNIVERSITIES GRADUATE PROGRAM

AUTHORIZING LEGISLATION

Higher Education Act of 1965 as amended (HEA), Title VIII, Part AA, Section 897 and Title VII, Subpart 4, Section 723.

Applicable Regulations:

Education Department Administrative Regulations (EDGAR), Parts 74, 75, 77, 79, 81, 82, 84, 85, 86, 97, 98 and 99.

1. OVERVIEW OF PROGRAM

Purpose:

The HBCU Masters Degree Program make grant awards to eligible institutions determined by the Secretary to be making a substantial contribution to graduate education opportunities at the masters level in the following areas: mathematics; engineering; the physical or natural sciences; computer science; information technology; nursing; allied health; or other scientific disciplines in which African Americans are underrepresented. The program provides grants for up to six years to establish or strengthen qualified masters degree programs in these fields at eligible institutions.

Eligibility:

Institutions eligible for grants are listed in the statute and include: Albany State University; Alcorn State University; Claflin University; Coppin State University; Elizabeth City State University; Fayetteville State University; Fisk University; Fort Valley State University; Grambling State University; Kentucky State University; Mississippi Valley State University; Savannah State University; South Carolina State University; University of Arkansas, Pine Bluff; Virginia State University; West Virginia State University; Wilberforce University; and Winston-Salem State University.

Authorized Activities:

Grant funds may be used for the following activities:

1. Purchase, rental, or lease of scientific or laboratory equipment for educational purposes, including instructional and research purposes;

2. Construction, maintenance, renovation, and improvement in classroom, library, laboratory, and other instructional facilities, including purchase or rental of telecommunications program materials;

3. Purchase of library books, periodicals, technical and other scientific journals, microfilm, microfiche, and other educational materials, including telecommunications program materials;

4. Scholarships, fellowships, and other financial assistance for needy graduate students to permit the enrollment of the students in, and completion of, a masters degree in mathematics, engineering, the physical or natural sciences, computer science, information technology, nursing, allied health, or other scientific disciplines in which African Americans are underrepresented;

5. Establishing or improving a development office to strengthen and increase contributions from alumni and the private sector;

6. Assisting in the establishment or maintenance of an institutional endowment to facilitate financial independence pursuant to section 331 of the HEA;

7. Funds and administrative management, and the acquisition of equipment, including software, for use in strengthening funds management and management information systems;

8. Acquisition of real property that is adjacent to the campus in connection with the construction, renovation, or improvement of, or an addition to, campus facilities;

9. Education or financial information designed to improve the financial literacy and economic literacy of students or the students’ families, especially with regard to student indebtedness and student assistance programs under Title IV of the HEA;

10. Tutoring, counseling, and student service programs designed to improve academic success;

11. Faculty professional development, faculty exchanges, and faculty participation in professional conferences and meetings; and

12. Other activities proposed in the application that contribute to carrying out the purposes of the program, and are approved by the Secretary as part of the review and acceptance of the application.

II. REQUIREMENTS AND FUNDING RULES

Qualified Masters Degree Program:

A qualified masters degree program means a masters degree program at an eligible institution that provides a program of instruction in mathematics, engineering, the physical or natural sciences, computer science, information technology, nursing, allied health, or other scientific disciplines in which African Americans are underrepresented and has students enrolled in such a program of instruction at the time of application.

An institution may use no more than 10% of its grant for the development of a new qualified masters degree program.

Institutional Choice:

The president or chancellor of the grantee institution may decide which graduate school or qualified masters degree program will receive funds under the grant in any one fiscal year, if the allocation of funds among the schools or programs is delineated in the application.

One Grant Rule and Other Grant Programs:

Institutions may not receive more than one grant in any fiscal year. No institution that is eligible for and receives a grant award under Section 326 (Historically Black Graduate Institutions Program), Section 512 (Promoting Postbaccalaureate Opportunities for Hispanic Americans program) or Section 724 (Predominantly Black Institutions Graduate Program) for a fiscal year shall be eligible to apply for or receive funds under this program for that same fiscal year.

Non-Federal Matching Funds:

If a grant in excess of $1,000,000 is made to any institution in a given fiscal year, that institution must provide assurances that 50 percent of the costs of the activities supported by the grant that exceed the $1,000,000 limit will be paid from non-Federal funds. No institution will be required to match any portion of the first $1,000,000 of that institution’s grant award for a fiscal year.

Minimum Grant Award:

Each eligible institution will receive a grant of no less than $500,000 for any fiscal year, unless the amount appropriated is not sufficient to pay the minimum grant awards to all eligible institutions; in this event, the amount paid to each eligible institution will be ratably reduced.

No eligible institution that receives a grant under this program for FY 2009 and that is eligible to receive a grant in a subsequent fiscal year shall receive a grant amount in any subsequent fiscal year that is less than the grant amount received for FY 2009, unless:

• The amount appropriated is not sufficient to provide such grant amounts to all eligible institutions that received grants in FY 2009 and are eligible to receive grants in a subsequent fiscal year; or

• The institution cannot provide sufficient matching funds to meet the requirements of the program statute.

Funding Formula:

Any amount appropriated for these programs during any fiscal year in excess of $9,000,000 shall be made available to each of the eligible institutions pursuant to a formula developed by the Secretary that uses the following elements:

1. The ability of the institution to match Federal funds with non-Federal funds;

2. The number of students enrolled in the qualified masters degree program at the eligible institution in the previous academic year;

3. The average cost of attendance per student, for all full-time students enrolled in the qualified masters degree program at the institution;

4. The number of students in the previous year who received a degree in the qualified masters degree program at each institution; and

5. The contribution, on a percent basis, of the programs for which the institution is eligible to receive funds under this program to the total number of African Americans receiving masters degrees in the disciplines related to the programs for the previous year.

Periodic Renewal of Grants:

Grants are awarded for up to six years. To receive continuation funding, grantee institutions must submit an Annual Performance Report, including detailed progress on funded activities and the goals and objectives cited in the original application, as well as updated data relating to formula elements. Program staff will contact grantee institutions with more details on this requirement later in the year.

Performance Indicators and Reporting:

The following performance measures were developed for this program by the U.S. Department of Education. Grantees will be required to report annually on their progress related to these measures. For more information, please see page 43 of this application, which describes the requirements of the Government Performance and Results Act (GPRA).

Enrollment

The percent change, over the period between the fall of the year the grant was issued and the fall after the end of the grant period, in the number of African American and/or low-income graduate students enrolled in the academic program(s) supported by the project.

Degrees Awarded

The percent change, over the fall semester before, in the number of African American and/or low-income students graduating in the academic program(s) supported by the project.

Time to Degree

Median time to completion of a masters degree for African Americans and/or low-income graduate students, in the academic program(s) supported by the project during the period of the grant award.

Efficiency Measure

Cost per successful outcome: Federal cost per masters degree earned by African American and/or low-income students, in the academic program(s) supported by the project during the period of the grant award.

Other Performance Measures

New Courses

Number of new courses, in the academic program(s) supported by the project, added as a result of this grant.

New Academic Concentrations

Number of academic concentrations, in the academic program(s) supported by the project, added as a result of this grant.

New Research Initiatives

Number of new research initiatives, in the academic program(s) supported by the project, added as a result of this grant.

Student Independent Research

Percentage of students participating in independent research, during the most recent complete academic year.

Student Research with Faculty

Percentage of students participating in research with faculty, during the most recent complete academic year.

Student Conference Presentations

Number of students presenting at conferences, during the most recent complete academic year.

Student Publications

Number of students writing for publication, during the most recent complete academic year.

Endowment Activities:

If your proposed project includes a request for endowment activities, please refer to the following:

Legislation:

HEA, Title III, Part C Endowment Challenge Grant Program

Regulations:

34 CFR Part 628, Endowment Challenge Grant Program

HIGHER EDUCATION OPPORTUNITY ACT OF 2008

PART AA—MASTERS AND POSTBACCALAUREATE PROGRAMS

‘SEC. 897. MASTERS DEGREE PROGRAMS.

In addition to any amounts appropriated under section 725, there are authorized to be appropriated, and there are appropriated, out of any funds in the Treasury not otherwise appropriated, $11,500,000 for fiscal year 2009 and for each of the five succeeding fiscal years to carry out subpart 4 of part A of title VII in order to provide grants under sections 723 and 724, in the minimum amount authorized under such sections, to all institutions eligible for grants under such sections.

SEC. 706. MASTERS DEGREE PROGRAMS AT HISTORICALLY BLACK COLLEGES AND UNIVERSITIES AND PREDOMINANTLY BLACK INSTITUTIONS.

(a) Technical Amendments.--Part A of title VII (as amended by this title) (20 U.S.C. 1134 et seq.) is further amended--

(1) by redesignating subpart 4 as subpart 5;

(2) in the heading of section 731, [NOTE: 20 USC 1137.] by striking ``subparts 1, 2, and 3'' and inserting ``subparts 1 through 4''; and

(3) in section 731--

(A) in subsections (a) and (b), by striking ``subparts 1, 2, and 3'' each place the term appears and inserting ``subparts 1 through 4''; and

(B) in subsection (d), by striking ``subpart 1, 2,or 3'' and inserting ``subpart 1, 2, 3, or 4''.

(b) Master's Degree Programs.--Part A of title VII (as amended by this title) (20 U.S.C. 1134 et seq.) is further amended by inserting after subpart 3 the following:

``Subpart 4--Masters Degree Programs at Historically Black Colleges and

Universities and Predominantly Black Institutions

``SEC. 723. [NOTE: 20 USC 1136a.] MASTERS DEGREE PROGRAMS A HISTORICALLY BLACK COLLEGES AND UNIVERSITIES.

``(a) Grant Program Authorized.--

``(1) In general.--Subject to the availability of funds appropriated to carry out this section, the Secretary shall award program grants to each of the institutions listed in subsection (b)(1) that is determined by the Secretary to be making a substantial contribution to graduate education opportunities at the masters level in mathematics, engineering, the physical or natural sciences, computer science, information technology, nursing, allied health, or other scientific disciplines for Black Americans.

``(2) Assurance of non-federal matching funds.--No grant in excess of $1,000,000 may be made under this section unless the institution provides assurances that 50 percent of the cost of the purposes for which the grant is made will be paid from non-Federal sources, except that no institution shall be required to match any portion of the first $1,000,000 of the institution's award from the Secretary. After funds are made available to each eligible institution under the funding rules described in subsection (f), the Secretary shall distribute, on a pro rata basis, any amounts which were not so made available (by reason of the failure of an institution to comply with the matching requirements of this paragraph) among the institutions that have complied with such matching requirement.

``(3) Minimum award.--Subject to subsections (f) and (g), the amount awarded to each eligible institution listed in subsection (b)(1) for a fiscal year shall be not less than $500,000.

``(4) Duration of grants.--A grant awarded under this section shall be for a period of not more than six years, but may be periodically renewed for a period to be determined by the Secretary.

``(b) Institutional Eligibility.--

``(1) In general.--Institutions eligible for grants under subsection (a) are the following:

``(A) Albany State University.

``(B) Alcorn State University.

``(C) Claflin University.

``(D) Coppin State University.

``(E) Elizabeth City State University.

``(F) Fayetteville State University.

``(G) Fisk University.

``(H) Fort Valley State University.

``(I) Grambling State University.

``(J) Kentucky State University.

``(K) Mississippi Valley State University.

``(L) Savannah State University.

``(M) South Carolina State University.

``(N) University of Arkansas, Pine Bluff.

``(O) Virginia State University.

``(P) West Virginia Sate University.

``(Q) Wilberforce University.

``(R) Winston-Salem State University.

``(2) Qualified masters degree program.--

``(A) In general.--For the purposes of this section, the term `qualified masters degree program' means a masters degree program that provides a program of instruction in mathematics, engineering, the physical or natural sciences, computer science, information technology, nursing, allied health, or other scientific disciplines in which African Americans are underrepresented and has students enrolled in such program of instruction at the time of application for a grant under this section.

``(B) Enrollment exception.--Notwithstanding the enrollment requirement contained in subparagraph (A), an institution may use an amount equal to not more than 10 percent of the institution's grant under this section for the development of a new qualified masters degree program.

``(3) Institutional choice.--The president or chancellor of the institution may decide which graduate school or qualified masters degree program will receive funds under the grant in any one fiscal year, if the allocation of funds among the schools or programs is delineated in the application for funds submitted to the Secretary under this section.

``(4) One grant per institution.--The Secretary shall not award more than one grant under this section in any fiscal year to any institution of higher education.

``(c) Application.--An eligible institution listed in subsection (b)(1) desiring a grant under this section shall submit an application at such time, in such manner, and containing such information as the Secretary may require. The application shall--

``(1) demonstrate how the grant funds under this section will be used to improve graduate educational opportunities for Black and low-income students, and lead to greater financial independence; and

``(2) provide, in the case of applications for grants in excess of $1,000,000, the assurances required under subsection (a)(2) and specify the manner in which the eligible institution is going to pay the non-Federal share of the cost of the application.

``(d) Uses of Funds.--A grant under this section may be used for--

``(1) purchase, rental, or lease of scientific or laboratory equipment for educational purposes, including instructional and research purposes;

``(2) construction, maintenance, renovation, and improvement in classroom, library, laboratory, and other instructional facilities, including purchase or rental of telecommunications technology equipment or services;

``(3) purchase of library books, periodicals, technical and other scientific journals, microfilm, microfiche, and other educational materials, including telecommunications program materials;

``(4) scholarships, fellowships, and other financial assistance for needy graduate students to permit the enrollment of the students in, and completion of, a masters degree in mathematics, engineering, the physical or natural sciences, computer science, information technology, nursing, allied health, or other scientific disciplines in which African Americans are underrepresented;

``(5) establishing or improving a development office to strengthen and increase contributions from alumni and the private sector;

``(6) assisting in the establishment or maintenance of an institutional endowment to facilitate financial independence pursuant to section 331;

``(7) funds and administrative management, and the acquisition of equipment, including software, for use in strengthening funds management and management information systems;

``(8) acquisition of real property that is adjacent to the campus in connection with the construction, renovation, or improvement of, or an addition to, campus facilities;

``(9) education or financial information designed to improve the financial literacy and economic literacy of students or the students' families, especially with regard to student indebtedness and student assistance programs under title IV;

``(10) tutoring, counseling, and student service programs designed to improve academic success;

``(11) faculty professional development, faculty exchanges, and faculty participation in professional conferences and meetings; and

``(12) other activities proposed in the application submitted under subsection (c) that--

``(A) contribute to carrying out the purposes of this section; and

``(B) are approved by the Secretary as part of the review and acceptance of such application.

``(e) Interaction With Other Grant Programs.--No institution that is eligible for and receives an award under section 326, 512, or 724 for a fiscal year shall be eligible to apply for a grant, or receive grant funds, under this section for the same fiscal year.

``(f) Funding Rule.--Subject to subsection (g), of the amount appropriated to carry out this section for any fiscal year--

``(1) the first $9,000,000 (or any lesser amount appropriated) shall be available only for the purposes of making minimum grants under subsection (a)(3) to eligible institutions listed in subparagraphs (A) through (R) of subsection (b)(1), except that if the amount appropriated is not sufficient to pay the minimum grant awards to all such eligible institutions, the amount of the minimum award to each such eligible institution shall be ratably reduced;

``(2) after the application of paragraph (1), an amount shall be available for the purpose of making minimum grants under subsection (a)(3) to eligible institutions listed in subsection (b)(1) that do not receive a grant under paragraph (1), if any, except that if the amount appropriated is not sufficient to pay the minimum grant awards to all such eligible institutions, the amount of the minimum award to each such eligible institution shall be ratably reduced; and

``(3) any amount in excess of $9,000,000 shall be made available to each of the eligible institutions identified in subparagraphs (A) through (R) of subsection (b)(1), pursuant to a formula developed by the Secretary that uses the following elements:

``(A) The ability of the institution to match Federal funds with non-Federal funds.

``(B) The number of students enrolled in the qualified masters degree program at the eligible institution in the previous academic year.

``(C) The average cost of attendance per student, for all full-time students enrolled in the qualified masters degree program at such institution.

``(D) The number of students in the previous year who received a degree in the qualified masters degree program at such institution.

``(E) The contribution, on a percent basis, of the programs for which the institution is eligible to receive funds under this section to the total number of African Americans receiving masters degrees in the disciplines related to the programs for the previous year.

``(g) Hold Harmless Rule.--Notwithstanding paragraphs (2) and (3) of subsection (f), no eligible institution identified in subsection (b)(1) that receives a grant under this section for fiscal year 2009 and that is eligible to receive a grant for a subsequent fiscal year shall receive a grant amount for any such subsequent fiscal year that is less than the grant amount received for fiscal year 2009, unless--

``(1) the amount appropriated is not sufficient to provide such grant amounts to all such institutions and programs that received grants under this section for such fiscal year and that are eligible to receive a grant in such subsequent fiscal year; or

``(2) the institution cannot provide sufficient matching funds to meet the requirements of this section.

``SEC. 725. [NOTE: 20 USC 1136c.] AUTHORIZATION OF APPROPRIATIONS.

``(a) Masters Degree Programs at Historically Black Colleges and

Universities.--There are authorized to be appropriated to carry out section 723 such sums as may be necessary for fiscal year 2009 and each of the five succeeding fiscal years.

INSTRUCTIONS FOR COMPLETING THE APPLICATION

An eligible institution desiring a grant under this program must submit an application that demonstrates how the grant funds will be used to improve graduate educational opportunities for Black and low-income American students, and lead to greater financial independence, and specify, if applicable, the manner in which the eligible institution will pay the non-Federal share of the costs of the activities described in the application.

Part I. Project Plan

1. Profile Page and Assurances

2. Abstract: Applicants must provide a one-page overview of the project and planned activities, demonstrating how the project will improve graduate educational opportunities for Black and low-income students, and lead to greater financial independence.

3. Narrative: Applicants must provide a project narrative of no more than 50 pages that includes the following:

• Overview: Give an overview of the institution and its qualified masters degree program(s), citing strengths and weaknesses as well as the institution’s goals and objectives. The narrative should describe how the institution plans to use grant funds to address these goals and objectives, including detailed plans for the first year of funding as well as long-term goals for the project period of up to six years.

• Activities: Identify all of the allowable activities listed in the statute and on pages 3 and 4 of this booklet for which the institution will use grant funds. Describe, in a comprehensive manner, an implementation strategy for each activity and a timetable for accomplishing these activities. Specifically identify how each funded activity will address a weakness and/or goal of the institution and its qualified masters degree program(s), and serve the overall purpose of the program as described the statute.

• Evaluation: Please describe the strategy to be used for evaluating the effectiveness of your project. For each funded activity and the goals and objectives it addresses, please describe the specific outcomes expected and provide performance indicators that are measurable and realistic. Be sure that your evaluation plan reflects your timetable for accomplishing funded activities and provides specific outcomes and performance indicators for the first year of funding as well as for the project period as a whole.

4. Goals and Objectives: For purposes of project evaluation, please complete the Goals and Objectives Form on page 16, identifying each goal or objective to be addressed, the activity(ies) that will address it, and a measurable outcome developed to evaluate success.

5. Budget Form and Narrative: Please complete Budget Summary Form 524 and the accompanying Budget Narrative. Please be sure to address all years of the project. In the Budget Narrative, for each Budget Category, list the individual activities associated with that category, and provide a detailed breakdown of the costs associated with that activity. Please be sure to include in the Budget Narrative all activities for which you are requesting funding, placing them in the appropriate Budget Categories, and account for all funds to be spent on each activity.

HBCU Masters Degree Programs

Profile Form and Program Assurances

1. L egal Name of Institution:

2. A ddress:

C ity: State: Zip:

3. Please list those qualified masters degree programs at the applicant institution, which will receive funds from this grant. (According to the Statute (Section 723(b)(2)(A) of the Higher Education Act of 1965, as amended (HEA), a qualified masters degree program means a masters degree program at an eligible institution that provides a program of instruction in mathematics, engineering, the physical or natural sciences, computer science, information technology, nursing, allied health, or other scientific disciplines in which African Americans are underrepresented and has students enrolled in such a program of instruction at the time of application.):

4. Will the institution be using grant funds under these programs to develop a new qualified masters degree program (see Enrollment exception, Section 723 (b)(2)(B) of the HEA)?

______ Yes ______ No

If yes, please identify the new qualified masters degree program to be developed:

If yes, by signing the bottom of this form, the institution certifies that no more than 10% of the institutions grant under these programs will be used to develop this new qualified masters degree program, as required by the statute governing these programs.

5. According to the statute governing the HBC Masters Degree Programs, no institution that is eligible for and receives a grant under the following programs shall be eligible to apply for a grant, or receive grant funds under this program for the same fiscal year:

   • Historically Black Graduate Institutions (HBGI) Program (Title III, Part B of the HEA)

   • Promoting Postbaccalaureate Opportunties for Hispanic Americans (PPOHA) program (Title V, Part B of the HEA)

   • Predominantly Black Institutions Graduate (PBIG) Program (Title VII, Subpart 4 of the HEA)

By signing the bottom of this form, the institution certifies that it will not apply for or receive funds from the HBGI, PPOHA, or PBIG programs during the same fiscal year that it applies for and receives funds under the HBCU Masters Degree Program.

6. _____ Check here if the applicant institution plans to use any program grant funds to establish or maintain an institutional endowment.

By signing the bottom of this form, the institution certifies that if it uses program funds to establish or maintain an institutional endowment, the institution agrees to abide by the Department of Education’s regulations governing the Endowment Challenge Grant Program, 34 CFR Part 628, and the program statute, Title III, Part C, Section 331 of the HEA.

Name of Institutional Representative (printed or typed):

Signature of Institutional Representative:

Date:

Goals and Objectives Form
Please provide a detailed description of the activities to be supported using program funding, measurable goals and objectives that these activities will address, and the proposed outcomes to be used to evaluate the success of the funded activities. Please make sure that this form reflects the goals, activities and outcomes described in your Project Narrative. If more space is required, please attach an additional sheet.
Goals and Objectives		Activities	Proposed Outcomes
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Part II. Formula Elements

Please provide all of the information requested on the Formula Elements form, and certify that the data is accurate. Formula elements may be found in the program statute, Title VII, Subpart 4, Sec.723 (f) (3). The data collected in this part of the application must be submitted by the institution annually by the deadline. If the space provided is insufficient, please attach an additional sheet.

Institution: __________________________________________________________

Formula Element A: The ability of the institution to match Federal Funds with non-Federal funds.

Has your institution matched Federal grant funds under a Federal program in the past five years?

___________Yes ___________ No

If YES, please provide the name of the Federal program, the amount of the institution’s matching contribution, and the fiscal year. If there was more than one Federal program under which your institution provided matching funds, please attach a sheet with that additional information.

Federal Program: _____________________________________________

Amount of Institutional Matching Contribution: $____________________

Fiscal Year in which the Matching took place: FY ___________________

Formula Element B: The number of students enrolled in the qualified masters degree program at the eligible institution in the previous academic year.

Qualified Masters Degree Program	Number of Students Enrolled in [insert year]
Total:

Formula Element C: The average cost of attendance per student, for all full-time students enrolled in the qualified masters degree program at the institution.

Average Cost of Attendance for Qualified Masters Degree Program Students: $___________________

Formula Element D: The number of students in the previous year who received a degree in the qualified masters degree program at each institution.

Qualified Masters Degree Program	Number of Graduates in [insert year]
Total:

Formula Element E: The contribution, on a percent basis, of the programs for which the institution is eligible to receive funds under this program to the total number of African Americans receiving masters degrees in the disciplines related to the programs for the previous year.

Column A	Column B	Column C	Column D
		(For ED Use Only: Do not fill in Columns C and D.)
Qualified Masters Degree Program	Number of African American Graduates in [insert year]	Number of African American Graduates in this Discipline Nationwide in [insert year]	Percent of Total
Total:

Please have the President of the institution sign below:

I attest to the accuracy of the data provided.

President’s Name: (please print or type):____________________________________

President’s Signature: ___________________________________________________

Date: ____________________________