84.31t

REQUIRED INFORMATION

Award Number P031T___________________________________________________

Project Director’s Name_________________________________________________

Project Director’s Telephone_____________________________________________

Project Director’s e-mail_________________________________________________

Level of Effort (at least 25%)______________________________________________

(how much time will project director devote to this grant ?)

President’s Name_______________________________________________________

President’s Telephone_____________________________________________________________

President’s e-mail______________________________________________________

13

84.031T Tribally Controlled Colleges and Universities Program Profile

INSTRUCTIONS: ALL applicants must complete these pages. DO NOT MODIFY OR AMEND THESE PAGES.

OPE ID #_____________

1. INSTITUTION (Legal Name):

_____________________________________________________________________

2. Are you applying as a Branch Campus? _____YES _____NO

3. ADDRESS (Applicants must indicate the address where the project will be located):

Project Address: _____________________________________________________________________

City: _____________________________________State: ______Zip: _____________

4. ENDOWMENT FUND ASSURANCE:

� By checking this box (or placing an “X” beside it), an applicant certifies that the institution of higher education proposes to use up to twenty percent (20%) of the Strengthening Institutions Program grant award, made under the authority of Title III, Part A of the Higher Education Act of 1965, as amended, to establish or increase the institution’s endowment fund. The institution agrees to abide by the Department of Education’s regulations governing the Endowment Challenge Grant Program, 34 CFR Part 628, the program statute, and the program regulations, 34 CFR Part 607. The institution further agrees to raise the required matching funds.

5. DATA FORM FOR DETERMINING INSTITUTIONAL INDIAN STUDENT COUNT

(as defined in Section 2(a) of the Tribally Controlled Colleges and Universities Assistance Act of 1978 (25 U.S.C. 1801(a))

1. total number of credit hours for Indian students enrolled at your institution

at the conclusion of the 3^rd week of the 2009 Fall Term =_____________

2. total credit hours for all Indian students enrolled in your institution at the conclusion of the 3^rd week of the 2010 Spring Term =_________________

3. total credit hours for Indian students enrolled in your institution in the

2009 Summer Term preceding the 2009 Fall Term= ________________

14

4. total credits earned by any Indian student during the 2009 Summer Term, 2009 Fall Term, or 2010 Spring Term at your institution who has not obtained a high school degree or its equivalent, if your institution has established criteria for the admission of that student on the basis of the student’s ability to benefit from the education or training offered. The admission procedures at your institution for such studies must include counseling or testing that measures the student’ aptitude to successfully complete the course in which the student has enrolled. No credits earned by the student for purposes of obtaining a high school degree or its equivalent may be counted in this total = __________________________

5. total credit hours for Indian Students enrolled in your institution’s Continuing Education Program during the 2009 Summer Term, 2009 Fall Term, or 2010 Spring Term, if your institution converts these credits hours basis in accordance with your institution’s system for providing students with credit for participation in your institution’s Continuing Education Program = ________________________

SUM of CREDIT HOURS (ITEMS a through e) = ________________________

20 U.S.C. 1801 (a)(1) defines the term “Indian” as “a person who is a member of an Indian tribe.”

Note: Applicant should retain data used to provide information to the Department for the funding period of the grant.

15