Eligibility Certification

ELIGIBILTY CERTIFICATION
NOTE: This form must be completed by the Authorized Representative applying for a Native American and Alaska Native Children in School Program for grant.
The following entities, when they operate elementary, secondary, and postsecondary schools predominant for Native American children (including Alaska Native children), are eligible applicants under this program: NCLBA of 2001,Title III,20USC 6822, Sec. 3112					Name of Institution/ Organization
Entity	Title	Signature	Date Signed	Telephone Number
Indian tribes.
Tribally sanctioned educational authorities.
Native Hawaiian or Native American Pacific Islander native language educational organizations.
Elementary schools or secondary schools that are operated or funded by the Bureau of Indian Education (BIE), or a consortium of such schools.
Elementary schools or secondary schools operated under a contract with or grant from the BIE in consortium with another such school or a tribal or community organization.
Elementary schools or secondary schools operated by the BIE and an IHE, in consortium with elementary schools or secondary schools operated under a contract with or a grant from the BIE or a tribal or community organization.

OMB Number 1885-0551 Expires / /

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 1885–0551. The time required to complete this information collection is estimated to average 5 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, DC 20202-4651. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Native American and Alaska Native Children in School Program, Office of English Language Acquisition, Language Enhancement, and Academic Achievement for Limited English Proficient Students, U.S. Department of Education, 400 Maryland Avenue, S.W., LBJ, Room 5C145, Washington, D.C. 20202-6510