Standard Application Forms

Att_TCCU APP FORMS[1].28.2010.doc

American Indian Tribally Controlled Colleges and Universities Program (1894-0001)

Standard Application Forms

OMB: 1840-0817

Document [doc]
Download: doc | pdf

OMB Number: 4040-0004

Expiration Date: 03/31/2012

Application for Federal Assistance SF-424

* 1. Type of Submission:

Preapplication

Application

Changed/Corrected Application

* 2. Type of Application:

New

Continuation

Revision

* If Revision, select appropriate letter(s):

*Other (Specify):

     

*

Completed by Grants.gov upon submission

3. Date Received: 4. Applicant Identifier:

     

5a. Federal Entity Identifier:

     

*5b. Federal Award Identifier:

     

State Use Only:

6. Date Received by State:      

7. State Application Identifier:      

8. APPLICANT INFORMATION:

* a. Legal Name:      

* b. Employer/Taxpayer Identification Number (EIN/TIN):

     

* c. Organizational DUNS:

     

d. Address:

* Street 1:      

Street 2:      

* City:      

County/Parish:      

*State:      

Province:      

*Country:      

* Zip / Postal Code:      

e. Organizational Unit:

Department Name:

     

Division Name:

     

f. Name and contact information of person to be contacted on matters involving this application:

P refix:       *First Name:      

Middle Name:      

* Last Name:      

Suffix:      

Title:      

Organizational Affiliation:

     

*Telephone Number:       Fax Number:      

*Email:      


Application for Federal Assistance SF-424

9 . Type of Applicant 1: Select Applicant Type:

Type of Applicant 2: Select Applicant Type:

Type of Applicant 3: Select Applicant Type:

*Other (Specify)

     

* 10 Name of Federal Agency:

     

11. Catalog of Federal Domestic Assistance Number:

     

CFDA Title:

     


* 12 Funding Opportunity Number:

     



* Title:

     




13. Competition Identification Number:

     

Title:

     




14. Areas Affected by Project (Cities, Counties, States, etc.):

     






* 15. Descriptive Title of Applicant’s Project:

     







Attach supporting documents as specified in agency instructions.







Application for Federal Assistance SF-424

1 6. Congressional Districts Of:

*a. Applicant:       *b. Program/Project:      


Attach an additional list of Program/Project Congressional Districts if needed.



1 7. Proposed Project:

*a. Start Date:       *b. End Date:      

18. Estimated Funding ($):

* a. Federal

* b. Applicant

* c. State

* d. Local

* e. Other

* f. Program Income

*g. TOTAL

     


     

     

     

     

     




* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?

a. This application was made available to the State under the Executive Order 12372 Process for review on      

b. Program is subject to E.O. 12372 but has not been selected by the State for review.

c. Program is not covered by E.O. 12372.

* 20. Is the Applicant Delinquent On Any Federal Debt? (If “Yes,” provide explanation in attachment.)

Yes No

If “Yes”, provide explanation and attach.


2 1. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U. S. Code, Title 218, Section 1001)

** I AGREE

** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions.

Authorized Representative:

P refix:       *First Name:      

M iddle Name:      

*Last Name:      

Suffix:      

* Title:      

* Telephone Number:      

Fax Number:      

* Email:      

*

Completed by Grants.gov upon submission


Signature of Authorized Representative:

*

Completed by Grants.gov upon submission


Date Signed:












































































SUPPLEMENTAL INFORMATION REQUIRED FOR DEPARTMENT OF EDUCATION


1. Project Director:


Prefix: *First Name: Middle Name: *LastName: Suffix:




Address:


* Street1:


Street2:


* City:


County:


* State * Zip Code: * Country:


* Phone Number (give area code) Fax Number (give area code)



Email Address:




2. Applicant Experience:


N ovice Applicant

Yes No Not applicable to this program

3. Human Subjects Research:


Are any research activities involving human subjects planned at any time during the proposed project Period?


Yes No


A re ALL the research activities proposed designated to be exempt from the regulations?



Yes Yes Provide Exemption(s) #:


No No Provide Assurance #, if available:


P lease attach an explanation Narrative:


20

ASSURANCES - NON-CONSTRUCTION PROGRAMS




Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503


PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.




Note: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified.


As the duly authorized representative of the applicant I certify that the applicant:


1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-Federal share of project cost) to ensure proper planning, management, and completion of the project described in this application.


2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives.


3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain.


4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.


5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).


6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on the basis of handicaps; (d)



the Age Discrimination Act of 1975, as amended (42 U.S.C.  6101-6107), which prohibits discrimination on the basis of

age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g)  523 and 527 of the Public Health Service Act of 1912 (42 U.S.C.  290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and (j) the requirements of any other nondiscrimination statute(s) which may apply to the application.


7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases.


8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds.



9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. 276a to 276a-7), the Copeland Act (40 U.S.C. 276c and 18 U.S.C. 874) and the Contract Work Hours and Safety Standards Act (40 U.S.C.  327-333), regarding labor standards for federally assisted construction subagreements.


10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.

11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. 1451 et seq.); (f) conformity of Federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. 7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205).

12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1721 et seq.) related to protecting components or potential components of the national wild and scenic rivers system.


13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).


14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance.


15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance.


16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.) which prohibits the use of lead- based paint in construction or rehabilitation of residence structures.


17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, Audits of States, Local Governments, and Non-Profit Organizations.


18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this program


SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL




TITLE


APPLICANT ORGANIZATION





DATE SUBMITTED







Standard Form 424B (Rev. 7-97) Back

U.S. DEPARTMENT OF EDUCATION

BUDGET INFORMATION

NON-CONSTRUCTION PROGRAMS

OMB Control Number: 1894-0008

Expiration Date: 02/28/2011

Name of Institution/Organization



Applicants requesting funding for only one year should complete the column under "Project Year 1." Applicants requesting funding for multi-year grants should complete all applicable columns. Please read all instructions before completing form.

SECTION A - BUDGET SUMMARY

U.S. DEPARTMENT OF EDUCATION FUNDS

Budget Categories

Project Year 1

(a)

Project Year 2

(b)

Project Year 3

(c)

Project Year 4

(d)

Project Year 5

(e)

Total

(f)

1. Personnel







2. Fringe Benefits







3. Travel







4. Equipment







5. Supplies







6. Contractual







7. Construction







8. Other







9. Total Direct Costs (lines 1-8)







10. Indirect Costs*







11. Training Stipends







12. Total Costs (lines 9-11)







*Indirect Cost Information (To Be Completed by Your Business Office):

If you are requesting reimbursement for indirect costs on line 10, please answer the following questions:

  1. Do you have an Indirect Cost Rate Agreement approved by the Federal government? ____Yes ____ No

  2. If yes, please provide the following information:

Period Covered by the Indirect Cost Rate Agreement: From: ___/___/______ To: ___/___/______ (mm/dd/yyyy)

Approving Federal agency: ____ ED ____ Other (please specify): __________________________ The Indirect Cost Rate is _________%

  1. For Restricted Rate Programs (check one) -- Are you using a restricted indirect cost rate that:

___ Is included in your approved Indirect Cost Rate Agreement? or ___ Complies with 34 CFR 76.564(c)(2)? The Restricted Indirect Cost Rate is _________%

ED 524 23




Name of Institution/Organization




Applicants requesting funding for only one year should complete the column under
"Project Year 1." Applicants requesting funding for multi-year grants should complete all applicable columns. Please read all instructions before completing form.

SECTION B - BUDGET SUMMARY

NON-FEDERAL FUNDS


Budget Categories

Project Year 1

(a)

Project Year 2

(b)

Project Year 3

(c)

Project Year 4

(d)

Project Year 5

(e)

Total

(f)








1. Personnel







2. Fringe Benefits







3. Travel







4. Equipment







5. Supplies







6. Contractual







7. Construction







8. Other







9. Total Direct Costs

(Lines 1-8)







10. Indirect Costs







11. Training Stipends







12. Total Costs

(Lines 9-11)







SECTION C – BUDGET NARRATIVE (see instructions)

ED 524

Instructions for ED 524



General Instructions


This form is used to apply to individual U.S. Department of Education (ED) discretionary grant programs. Unless directed otherwise, provide the same budget information for each year of the multi-year funding request. Pay attention to applicable program specific instructions, if
attached. You may access the Education Department General Administrative Regulations, 34 CFR 74 – 86 and 97-99, on ED’s website at:

http://www.ed.gov/policy/fund/reg/edgarReg/edgar.html



You must consult with your Business Office prior to submitting this form.

Section A - Budget Summary

U.S. Department of Education Funds


All applicants must complete Section A and provide a break-down by the applicable budget categories shown in lines 1-11.



Lines 1-11, columns (a)-(e): For each project year for which funding is requested, show the total amount requested for each applicable budget category.



Lines 1-11, column (f): Show the multi-year total for each budget category. If funding is requested for only one project year, leave this column blank.



Line 12, columns (a)-(e): Show the total budget request for each project year for which funding is requested.



Line 12, column (f): Show the total amount requested for all project years. If funding is requested for only one year, leave this space blank.





Indirect Cost Information: If you are requesting reimbursement for indirect costs on line 10, this information is to be completed by your Business Office. (1): Indicate whether or not your organization has an Indirect Cost Rate Agreement that was approved by the Federal government.

If you checked “no,” ED generally will authorize grantees to use a temporary rate of 10 percent of budgeted salaries and wages subject to the following limitations:

(a) The grantee must submit an indirect cost proposal to its cognizant agency within 90 days after ED issues a grant award notification; and

(b) If after the 90-day period, the grantee has not submitted an indirect cost proposal to its cognizant agency, the grantee may not charge its grant for indirect costs until it has negotiated an indirect cost rate agreement with its cognizant agency.

(2): If you checked “yes” in (1), indicate in (2) the beginning and ending dates covered by the Indirect Cost Rate Agreement. In addition, indicate whether ED, another Federal agency (Other) or State agency issued the approved agreement. If you check “Other,” specify the name of the Federal or other agency that issued the approved agreement.

(3): If you are applying for a grant under a Restricted Rate Program (34 CFR 75.563 or 76.563), indicate whether you are using a restricted indirect cost rate that is included on your approved Indirect Cost Rate Agreement or whether you are using a restricted indirect cost rate that complies with 34 CFR 76.564(c)(2). Note: State or Local government agencies may not use the provision for a restricted indirect cost rate specified in 34 CFR 76.564(c)(2). Check only one response. Leave blank, if this item is not applicable.



Section B - Budget Summary

Non-Federal Funds



If you are required to provide or volunteer to provide cost-sharing or matching funds or other non-Federal resources to the project, these should be shown for each applicable budget category on lines 1‑11 of Section B.



Lines 1-11, columns (a)-(e): For each project year, for which matching funds or other contributions are provided, show the total contribution for each applicable budget category.



Lines 1-11, column (f): Show the multi-year total for each budget category. If non-Federal contributions are provided for only one year, leave this column blank.



Line 12, columns (a)-(e): Show the total matching or other contribution for each project year.



Line 12, column (f): Show the total amount to be contributed for all years of the multi-year project. If non-Federal contributions are provided for only one year, leave this space blank.


Section C - Budget Narrative [Attach separate sheet(s)]

Pay attention to applicable program specific instructions,
if attached.


  1. Provide an itemized budget breakdown, and justification by project year, for each budget category listed in Sections A and B. For grant projects that will be divided into two or more separately budgeted major activities or sub-projects, show for each budget category of a project year the breakdown of the specific expenses attributable to each sub-project or activity.





  1. For non-Federal funds or resources listed in Section B that are used to meet a cost-sharing or matching requirement or provided as a voluntary cost-sharing or matching commitment, you must include:





a. The specific costs or contributions by budget category;

b. The source of the costs or contributions; and

c. In the case of third-party in-kind contributions, a description of how the value was determined for the donated or contributed goods or services.





[Please review ED’s general cost sharing and matching regulations, which include specific limitations, in 34 CFR 74.23, applicable to non-governmental entities, and 80.24, applicable to governments, and the applicable Office of Management and Budget (OMB) cost principles for your entity type regarding donations, capital assets, depreciation and use allowances. OMB cost principle circulars are available on OMB’s website at: http://www.whitehouse.gov/omb/circulars/index.html]



  1. If applicable to this program, provide the rate and base on which fringe benefits are calculated.



  1. If you are requesting reimbursement for indirect costs on line 10, this information is to be completed by your Business Office. Specify the estimated amount of the base to which the indirect cost rate is applied and the total indirect expense. Depending on the grant program to which you are applying and/or your approved Indirect Cost Rate Agreement, some direct cost budget categories in your grant application budget may not be included in the base and multiplied by your indirect cost rate. For example, you must multiply the indirect cost rates of “Training grants" (34 CFR 75.562) and grants under programs with “Supplement not Supplant” requirements ("Restricted Rate" programs) by a “modified total direct cost” (MTDC) base (34 CFR 75.563 or 76.563). Please indicate which costs are included and which costs are excluded from the base to which the indirect cost rate is applied.


When calculating indirect costs (line 10) for "Training grants" or grants under "Restricted Rate" programs, you must refer to the information and examples on ED’s website at: http://www.ed.gov/fund/grant/apply/appforms/appforms.html.


You may also contact (202) 377-3838 for additional information regarding calculating indirect cost rates or general indirect cost rate information.



  1. Provide other explanations or comments you deem necessary.


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 1894-0008. The time required to complete this information collection is estimated to vary from 13 to 22 hours per response, with an average of 17.5 hours per response, including the time to review instructions, search existing data sources, 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 (insert program office), U.S. Department of Education, 400 Maryland Avenue, S.W., Washington, D.C. 20202.


CERTIFICATION REGARDING LOBBYING


Certification for Contracts, Grants, Loans and Cooperative Agreements.


The undersigned certifies, to the best of his or her knowledge and belief, that:


(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal Loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan or cooperative agreement.


(2) If any funds other Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loam or cooperative agreement, the undersigned shall complete and submit Standard Form – LLL, “Disclosure of Lobbying Activities,” in accordance with its instructions.


(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.


Statement for Loan Guarantees and Loan Insurance.


The undersigned states, to the best of his or her knowledge and belief, that:


If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee or any agency, a member of Congress, an officer or employee of Congress or an employee of a Member of Congress in connection with this commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, “Disclosure of Lobbying Activities,” in accordance with its instructions. Submission of this statement is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.



Applicant’s Organization





Printed Name of Authorized Representative Printed Title of Authorized Representative




Signature Date





ED 80-0013 26



Approved by OMB

0348-0046

Disclosure of Lobbying Activities

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352

(See reverse for public burden disclosure)

Disclosure of Lobbying Activities (SF-LLL)


  1. Type of Federal Action:

a. contract

____ b. grant

c. cooperative agreement

d. loan

e. loan guarantee

f. loan insurance


  1. Status of Federal Action:

a. bid/offer/application

_____ b. initial award

c. post-award


  1. Report Type:

a. initial filing

_____ b. material change


For material change only:

Year _______ quarter _______

Date of last report___________

  1. Name and Address of Reporting Entity:

____ Prime _____ Subawardee

Tier______, if Known:






Congressional District, if known:

  1. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime:







Congressional District, if known:

  1. Federal Department/Agency:





7. Federal Program Name/Description:



CFDA Number, if applicable: __________________

  1. Federal Action Number, if known:


9. Award Amount, if known:


$

10. a. Name and Address of Lobbying Registrant

(if individual, last name, first name, MI):






b. Individuals Performing Services (including address if different from No. 10a)

(last name, first name, MI):





11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.


Signature: __________________________________


Print Name: _____


Title: _____


Telephone No.: ____________ Date: _______


Federal Use Only


Authorized for Local Reproduction

Standard Form - LLL (Rev. 7-97)


27

Purpose: The Federal government is committed to ensuring that all qualified applicants, small or large, non-religious or faith-based, have an equal opportunity to compete for Federal funding. In order for us to better understand the population of applicants for Federal funds, we are asking nonprofit private organizations (not including private universities) to fill out this survey.


Upon receipt, the survey will be separated from the application. Information provided on the survey will not be considered in any way in making funding decisions and will not be included in the Federal grants database. While your help in this data collection process is greatly appreciated, completion of this survey is voluntary.

Instructions for Submitting the Survey: If you are applying using a hard copy application, please place the completed survey in an envelope labeled “Applicant Survey.” Seal the envelope and include it along with your application package. If you are applying electronically, please submit this survey along with your application.




Survey on Ensuring Equal Opportunity for Applicants

OMB No. 1894-0010 Exp. 05/31/2012



Applicant’s (Organization) Name: ______________________________________________________________

Applicant’s DUNS Number: ___________________________________________________________________

Federal Program: __________________________________________________CFDA Number: ___________



1. Has the applicant ever received a grant or contract from the Federal government?


Yes No



2. Is the applicant a faith-based organization?

Yes No



3. Is the applicant a secular organization?

Yes No



4. Does the applicant have 501(c)(3) status?

Yes No



5. Is the applicant a local affiliate of a national
organization?


Yes No


6. How many full-time equivalent employees does the applicant have? (Check only one box).


3 or Fewer 15-50

4 -5 51-100

6-14 over 100


7. What is the size of the applicant’s annual budget? (Check only one box.)


Less Than $150,000

$150,000 - $299,999

$300,000 - $499,999

$500,000 - $999,999

$1,000,000 - $4,999,999


$5,000,000 or more

Executive Order 12372 (Intergovernmental Review of Federal Programs)



This program falls under the rubric of Executive Order 12372 (Intergovernmental Review of Federal Programs) and the regulations in 34 CFR Part 79. One of the objectives of the Executive order is to strengthen federalism--or the distribution of responsibility between localities, States, and the Federal government--by fostering intergovernmental partnerships. This idea includes supporting processes that State or local governments have devised for coordinating and reviewing proposed Federal financial grant applications.

The process for doing this requires grant applicants to contact State Single Points of Contact for information on how this works. Multi-state applicants should follow procedures specific to each state.

Further information about the State Single Point of Contact process and a list of names by State can be found at:



http://www.whitehouse.gov/omb/grants/spoc.pdf



Absent specific State review programs, applicants may submit comments directly to the Department. All recommendations and comments must be mailed or hand-delivered by the date indicated in the actual application notice to the following address: The Secretary, EO 12372--CFDA# [commenter must insert number--including suffix letter, if any], U.S. Department of Education, room 7E200. 400 Maryland Avenue, SW., Washington, DC 20202.

Proof of mailing will be determined on the same basis as applications (see 34 CFR §75.102). Recommendations or comments may be hand-delivered until 4:30 p.m. (eastern time) on the closing date indicated in this notice.

Important note: The above address is not the same address as the one to which the applicant submits its completed applications. Do not send applications to the above address.




















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OMB Control No. 1894-0005 (Exp. 01/31/2011)

NOTICE TO ALL APPLICANTS


The purpose of this enclosure is to inform you about a new provision in the Department of Education's General Education Provisions Act (GEPA) that applies to applicants for new grant awards under Department programs. This provision is Section 427 of GEPA, enacted as part of the Improving America's Schools Act of 1994 (Public Law (P.L.) 103-382).


To Whom Does This Provision Apply?


Section 427 of GEPA affects applicants for new grant awards under this program. ALL APPLICANTS FOR NEW AWARDS MUST INCLUDE INFORMATION IN THEIR APPLICATIONS TO ADDRESS THIS NEW PROVISION IN ORDER TO RECEIVE FUNDING UNDER THIS PROGRAM.


(If this program is a State-formula grant program, a State needs to provide this description only for projects or activities that it carries out with funds reserved for State-level uses. In addition, local school districts or other eligible applicants that apply to the State for funding need to provide this description in their applications to the State for funding. The State would be responsible for ensuring that the school district or other local entity has submitted a sufficient section 427 statement as described below.)


What Does This Provision Require?


Section 427 requires each applicant for funds (other than an individual person) to include in its application a description of the steps the applicant proposes to take to ensure equitable access to, and participation in, its Federally-assisted program for students, teachers, and other program beneficiaries with special needs. This provision allows applicants discretion in developing the required description. The statute highlights six types of barriers that can impede equitable access or participation: gender, race, national origin, color, disability, or age. Based on local circumstances, you should determine whether these or other barriers may prevent your students, teachers, etc. from such access or participation in, the Federally-funded project or activity. The description in your application of steps to be taken to overcome these barriers need not be lengthy; you may provide a clear and succinct description of how you plan to address those barriers that are applicable to your circumstances. In addition, the information may be provided in a single narrative, or, if appropriate, may be discussed in connection with related topics in the application.


Section 427 is not intended to duplicate the requirements of civil rights statutes, but rather to ensure that, in designing their projects, applicants for Federal funds address equity concerns that may affect the ability of certain potential beneficiaries to fully participate in the project and to achieve to high standards. Consistent with program requirements and its approved application, an applicant may use the Federal funds awarded to it to eliminate barriers it identifies.


What are Examples of How an Applicant Might Satisfy the Requirement of This Provision?


The following examples may help illustrate how an applicant may comply with Section 427.


(1) An applicant that proposes to carry out an adult literacy project serving, among others, adults with limited English proficiency, might describe in its application how it intends to distribute a brochure about the proposed project to such potential participants in their native language.


(2) An applicant that proposes to develop instructional materials for classroom use might describe how it will make the materials available on audio tape or in braille for students who are blind.


(3) An applicant that proposes to carry out a model science program for secondary students and is concerned that girls may be less likely than boys to enroll in the course, might indicate how it intends to conduct "outreach" efforts to girls, to encourage their enrollment.


We recognize that many applicants may already be implementing effective steps to ensure equity of access and participation in their grant programs, and we appreciate your cooperation in responding to the requirements of this provision.


Government Performance and Results Act (GPRA)



What is GPRA?


The Government Performance and Results Act of 1993 (GPRA) is a straightforward statute that requires all federal agencies to manage their activities with attention to the consequences of those activities. Each agency is to clearly state what it intends to accomplish, identify the resources required, and periodically report their progress to the Congress. In so doing, it is expected that the GPRA will contribute to improvements in accountability for the expenditures of public funds, improve Congressional decision-making through more objective information on the effectiveness of federal programs, and promote a new government focus on results, service delivery, and customer satisfaction.


How has the Department of Education Responded to the GPRA Requirements?


As required by GPRA, the Department of Education has prepared a strategic plan for 2007-2012. This plan reflects the Department’s priorities and integrates them with its mission and program authorities and describes how the Department will work to improve education for all children and adults in the U.S. The Department’s goals, as listed in the plan, are:


Goal 1: Increase student achievement, reward qualified teachers, and renew troubled schools so that every student can read and do math at grade level by 2014, as called for by the No Child Left Behind Act.

Goal 2: Encourage more rigorous and advanced coursework to improve the academic performance of our middle and high school students.

Goal 3: Work with colleges and universities to improve access, affordability, and accountability, so that our higher education system remains the world’s finest.


What are the Performance Indicators for the Title III, Part A Programs?


The performance indicators for the Title III, Part A Programs are part of the Department’s plan for meeting Goal 3. The Department’s specific goal for this program is “to increase enrollments of Strengthening Institutions Program (SIP) institutions.”


The Title III, Part A Programs’ overarching goal is “to improve the capacity of minority-serving institutions, which traditionally have limited resources and serve large numbers of low-income and minority students, to improve student success and to provide high-quality educational opportunities for their students.





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The performance indicators for the Title III, Part A Programs are:


  1. The number of full-time degree-seeking undergraduates enrolled at institutions of higher education (IHEs). Note that this is a long-term measure, which will be used periodically to gauge performance, beginning in FY 2009.

  2. The percentage of full-time undergraduate students who were in their first year of postsecondary enrollment in the previous year and are enrolled in the current year at the same institution.

  3. The cost per successful program outcome: federal cost per undergraduate and graduate degree at institutions.

  4. The percentage of students enrolled at four-year IHEs graduating within six years of enrollment.

  5. The percentage of students enrolled at two-year IHEs who graduate within three years of enrollment.


How does the Department of Education determine whether performance goals have been met?


An applicant that receives a grant award will be required to submit annual progress reports and a final report as a condition of the award. The reports will document the extent to which project goals and objectives are met.


The most recent version of this program’s annual performance report can be viewed at http://www.ed.gov/programs/iduestitle3a/performance.html.










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Application Checklist



Use This Checklist While Preparing Your Application Package: All items listed on this checklist are required.





    • Required Information Form



    • Profile Data Form


    • Application for Federal Assistance (SF 424 )



    • Department of Education Supplemental Information Form for the SF 424



    • Budget Summary (ED Form 524) Section A



    • One Page Abstract


    • Budget Narrative


    • Project Narrative Attachment Form







      • Assurances – Non-Construction Programs (ED 424B)

      • Disclosure of Lobbying Activities (SF LLL)

      • ED GEPA Section 427 Requirement

      • Survey on Ensuring Equal Opportunity for Applicants

      • Certification Regarding Lobbying (ED 80-0013)



















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File Typeapplication/msword
File TitleGrant Application Forms
AuthorJessica.Simpson
Last Modified By#Administrator
File Modified2010-05-26
File Created2010-04-29

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