MD HBCU APR Cover

OMB No. 1840-0813

Exp.

OMB No. 1875-0106

Exp. 06/30/2001

OMB No. 1875-0106

Exp. 06/30/2001

U.S. Department of Education

Historically Black Colleges and Universities Master’s Degree Program

Annual Performance Report

FY 2014 Academic Year 2012-2013

1. PR/Award #: _______________________________________

2. Name of Grantee: __________________________________________________________________________________________________

3. Grantee Address: __________________________________________________________________________________________________

4. Name of Project Director/Contact Person:_______________________________________________________________

Phone: ( ) ________ - __________ Ext: ( ) Fax: ( ) ________ - __________

Email Address: __________________________________________________

5. Name of Certifying Official:__________________________________________________________________________

Phone: ( ) ________ - __________ Ext: ( ) Fax: ( ) ________ - __________

Email Address: __________________________________________________

6. Reporting Period: From: _____/_____/_______ To: _____/_____/_______

(Month/Day/Year) (Month/Day/Year)

To the best of our knowledge and belief, all data in this performance report are true and correct and the report fully discloses all known weaknesses concerning the accuracy, reliability, and completeness of the data.

Name of Project Director (Print): ____________________________________________________________

Signature: _____________________________________________________ Date: _____/_____/_______

Name of Certifying Official (Print): ___________________________________________________________

Signature: _____________________________________________________ Date: _____/_____/_______

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 1840-0813. The time required to complete this information collection is estimated to average 35 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, DC 20202-4651. If you have comments or concerns regarding the status of your individual submission of the form, write directly to: Frederick Winter, HBCU Master’s Degree Program, U.S. Department of Education, 1990 K Street, N.W., Suite 6153, Washington, DC 20006-8544.