HUD Form 53153 Choice Neighborhoods Inadequate Schools Form

OMB Approval No. 2577-0269

(exp. 2/28/2011)

CHOICE NEIGHBORHOODS

Inadequate Schools Form

Complete the following form, if necessary, in response to one of the criterion of the Eligible Neighborhoods threshold which pertains to Inadequate Schools (Section III.C.2 of the NOFA).

Lead Applicant: _____________________________________ __________

Name of Targeted Public and/or Assisted Housing Site(s):

_______________________ ____________________

Name of School:

In accordance with the Department of Education’s definitions (included in Section I.C of the NOFA), the school named above is a:

_____ Low-performing school

_____ Persistently lowest-achieving school

Indicate the school’s relationship with the neighborhood:

_____ The school named above is located within the boundaries of the target neighborhood.

_____ At least 20% of children from the target public and/or assisted housing attend the school named above.

You must provide evidence from the State Education Agency that the identified school meets the relevant definition. Acceptable documentation includes a letter of certification, report, or printout from the website listing with URL.

HUD Form 53153 (3/2011)