Grant Forms

OMB Number: 4040-0004
Expiration Date: 03/31/2012

Application for Federal Assistance SF-424
* 1. Type of Submission:

* 2. Type of Application:

Preapplication

New

Application

Continuation

Changed/Corrected Application

Revision

* 3. Date Received:

* If Revision, select appropriate letter(s):

* Other (Specify):

4. Applicant Identifier:

Completed by Grants.gov upon submission.

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:
* Street1:
Street2:
* City:
County/Parish:
* State:
Province:

USA: UNITED STATES

* 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:
Prefix:

* First Name:

Middle Name:
* Last Name:
Suffix:
Title:
Organizational Affiliation:

* Telephone Number:
* Email:

Fax Number:

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.):

Add Attachment

* 15. Descriptive Title of Applicant's Project:

Attach supporting documents as specified in agency instructions.

Add Attachments

Delete Attachments

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Application for Federal Assistance SF-424
16. Congressional Districts Of:
* a. Applicant

* b. Program/Project

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

Add Attachment

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17. 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
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21. *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:
Prefix:

* First Name:

Middle Name:
* Last Name:
Suffix:
* Title:
* Telephone Number:

Fax Number:

* Email:
* Signature of Authorized Representative:

Completed by Grants.gov upon submission.

* Date Signed:

Completed by Grants.gov upon submission.

SUPPLEMENTAL INFORMATION
REQUIRED FOR
DEPARTMENT OF EDUCATION
1. Project Director:
Prefix:

*First Name:

Middle Name:

*Last Name:

Suffix:

Address:
* Street1:
Street2:
* City:
County:
* State

* Zip Code:

* Phone Number (give area code)

* Country:

Fax Number (give area code)

Email Address:

2. Applicant Experience:
Novice 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

Are ALL the research activities proposed designated to be exempt from the regulations?
Yes

Provide Exemption(s) #:

No

Provide Assurance #, if available:

Please attach an explanation Narrative:
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OMB Control No. 1894-0007
Expiration Date: 05/31/2011

U.S. DEPARTMENT OF EDUCATION
BUDGET INFORMATION
NON-CONSTRUCTION PROGRAMS

OMB Control Number: 1894-0008
Expiration Date: 02/28/2011

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.

Name of Institution/Organization

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

(3)

____ Other (please specify): __________________________ The Indirect Cost Rate is _________%

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

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)

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

Project Year 5
(e)

Total
(f)

DISCLOSURE OF LOBBYING ACTIVITIES

Approved by OMB

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
0348-0046
(See reverse for public burden disclosure.)
1. Type of Federal Action:
2. Status of Federal Action:
3. Report Type:
a. contract
a. bid/offer/application
a. initial filing
b. grant
b. initial award
b. material change
c. cooperative agreement
c. post-award
For Material Change Only:
d. loan
year _________ quarter _________
e. loan guarantee
date of last report ______________
f. loan insurance
4. Name and Address of Reporting Entity:
5. If Reporting Entity in No. 4 is a Subawardee, Enter Name
Subawardee
and Address of Prime:
Prime
Tier ______, if known :

Congressional District, if known :
6. Federal Department/Agency:

Congressional District, if known :
7. Federal Program Name/Description:

CFDA Number, if applicable : _____________
8. 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 ):

requested through this form is authorized by title 31 U.S.C. section
11. Information
1352. This disclosure of lobbying activities is a material representation of fact

Signature:

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 that $10,000 and not more than $100,000 for
each such failure.

Federal Use Only:

Print Name:
Title:
Telephone No.: _______________________ Date:
Authorized for Local Reproduction
Standard Form LLL (Rev. 7-97)

SURVEY ON ENSURING EQUAL OPPORTUNITY FOR APPLICANTS
OMB NO. 1894-0010 EXP. 05/31/2012

Purpose: The Federal government is committed to ensuring that all qualified applicants, small or large, non-religious or faithbased, 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.

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

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.)

3. Is the applicant a secular organization?
Less Than $150,000
Yes

No
$150,000 - $299,999

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

No

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

No

$300,000 - $499,999
$500,000 - $999,999
$1,000,000 - $4,999,999
$5,000,000 or more