Track Changes EASIE Part II

U.S. DEPARTMENT OF EDUCATION
OFFICE OF ELEMENTARY AND SECONDARY EDUCATION
WASHINGTON, DC 20202-6335

INDIAN EDUCATION PROGRAMS
Application for Formula Grants to
Local Educational Agencies
CFDA Number: 84.060

Formula Grant EASIE
(Electronic Application System for Indian Education)

Part II

Disclaimer:
This is not a paper application but a hardcopy representation of the EASIE online
system. Applicants must apply on EASIE
unless they qualify for and receive a
paper application.
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 Formula Grant EASIE (Electronic Application
System for Indian Education) is 1810-0021. The time required to complete the information collection is estimated to average 7.309.4
hours per response, inclusive of both Part I and Part II, 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 or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 202024700. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Office of
Indian Education, U.S. Department of Education, Lyndon B. Johnson Building, 400 Maryland Avenue, S.W., Room 3E205,
Washington, DC 20202-6335.

U.S. DEPARTMENT OF EDUCATION
Office of Indian Education
This package contains instructions and forms for Part II of the grant applications for the Formula Grants to Local
Educational Agencies Program (CFDA 84.060). The purpose of the Indian Education Formula Grant program,
authorized in Part A, Subpart 1, of Title VII of the Elementary and Secondary Education Act (the Act), is to assist
eligible applicants to provide Indian students with the opportunity to meet the same challenging state standards as
all other students and meet the unique educational and culturally related academic needs of American Indian and
Alaska Native students. The Act and the instructions in this application package are to be used in developing Part
II of your application. Your application provides funds for your school year (SY) 2014-1513–14 project.

General Instructions
Applying for Funds
Applicants for grants from the U.S. Department of Education (ED) must compete for limited funds. Deadlines
assure that all applicants are treated fairly, equally, and without last minute haste.
The rules, including the deadline, for applying for each grant are published, individually, in the Federal Register.
A one-year subscription to the Federal Register may be ordered from the U.S. Government Printing Office,
Washington, D.C. 20402-9371. Order from http://bookstore.gpo.gov. The Federal Register is also available free
on the Web at http://www.federalregister.gov.
The instructions in the Federal Register must be followed exactly. Do not accept any other advice you may
receive. No ED employee is authorized to extend any deadline published in the Federal Register.
Questions regarding submission of applications may be addressed to:
U.S. Department of Education
Office of Indian Education
400 Maryland Ave., SW
Washington, D.C. 20202-6335
Formula Grant EASIE. The method for applying for funds for this program is Web-based, using the Formula
Grant Electronic Application System for Indian Education (Formula Grant EASIE). Please see
http://www.EASIE.org/ to register for access to Formula Grant EASIE. If you need assistance, please contact our
Partner Support Center:
U.S. Department of Education Partner Support Center
Telephone: 877-457-3336 (877-HLP-EDEN)
Fax: 888-329-3336 (888-FAX-EDEN)
TTY/TDD: 888-403-3336 (888-403-EDEN)
[email protected]
Paper submission. Paper submission is permitted with pre-arrangements for districts that are unable to use
Web-based submission because they have no Internet connection or inadequate Web access. For paper
submission, contact the U.S. Department of Education EDEN Partner Support Center as shown above.
If you are a district that made pre-arrangements and are submitting a paper form, please follow the directions in
the Federal Register notice for submitting your paper application. Use the forms that you received in response to
your request for paper submission, not the sample forms attached to these instructions.

Two Parts of the Application; Deadlines
Applications submitted must address all required information in order to be funded.


Part I of the application consists of the Indian Student Count. The deadline for Part I is March 8,
2013February 28, 2014.



If Part I is submitted by the closing date, you will complete an application for Part II. The deadline for Part II
is May 30, 2014. Part II of the application contains five sections:
o Section 1. General Applicant Information: requests identifying information about the
entity or entities applying for funds.

o



Section 2. Coordination of Services for American Indian/Alaska Native Students:
requests information about your LEA’s comprehensive program, which may be funded
through a combination of local, State, and/or federal funds.
o Section 3. Project Description: requests information about the objectives, activities, and
evaluation of your proposed Indian Education formula grant project.
o Section 4. Budget Information Informationfor Indian Education Formula Grant Funds:
requests information about how you plan to spend the Indian Education formula grant funds.
o Section 5. Forms and Additional InformationOther Project Information Required of all
Applicants: contains Program Assurances and certification document
o Section 6. contains, Waiver Request and Waiver Use Report Forms, information for
Applications Under 7116, Integration of Services, Parent Committee Approval form, Sample
Consortium Agreement form, Sample Agreement for Tribes Applying in Lieu of LEAs, and
comment box for any additional information.
If Part I is submitted by the closing date, you will complete an application for Part II in which you will describe
the performance of students in your school system, identify your program objectives and how they will be
measured, and provide details on the budget for your project. The deadline for Part II is May 14, 2013.

Late Applications
Late applications will not be accepted., for the 2013-14 school year and all subsequent years. All applicants must
meet the pre-established deadlines for both Part I and Part II to be eligible for funding.

Transmittal Instructions for Formula Grant EASIE
Using Formula Grant EASIE. If you use the online Formula Grant EASIE, application information is transmitted
electronically to the Department. Be sure that you complete the certification screen by clicking the [I
CERTIFY] button. If you don’t click the [I CERTIFY] button, your application is not complete and is not
transmitted. After you certify, click [Continue] and download the PDF file of your application to your computer or
to a disk. You must do this before the due date of the application period. This is your permanent record.

Specific Instructions for Part II
Contact Information, Allocation, and Student Count. This information will be pre-entered for you based on the
information you provided with your Part I application.
Required Items. This application package includes 26 28 numbered items in 6 sections; each numbered item
consists of one or more questions or one or more tables. Which items you must complete and submit is
determined by several factors.
Type of application (your response to item 1)
 If you are applying as a regular formula grant program, then you must complete and submit items 1 –
20b. Item 20b requires the original signature of an authorized official from your LEA.
 If you are applying as a formula grant project consolidated with a Title I school-wide program, then you
must complete and submit items 1-85, 10, 19, and 2018-20b.. Item 20b requires the original signature of
an authorized official from your entity.
 If you are applying for integration of services under ESEA section 7116, then you must complete and
submit items 1-85, 10, 19, 20, 2318-20a, 23 and 24. Item 20b requires the original signature of an
authorized official from your LEA.
Single entity applicant or multi-entity applicant
 If you are a single-entity applicant (a single LEA, or a single BIE school, or a tribe applying in lieu of a
single LEA), then you must complete each of the required items once for your project, using data for that
entity.
 If you are a multi-entity applicant (a consortium of LEAs, a consortium of BIE schools, or a tribe applying
in lieu of multiple LEAs) then use the following guidelines for submitting required items.
o Complete the following items once for each participating LEA in your project: items 3 – 81-5.
o Complete the remaining required items once for your project; the information covers all
participating LEAs.
o

Complete the Sample Consortium Agreement form, item on page 27, inclusive of all participating
LEAs and submit on or before the EASIE part II deadline.

Administrative Costs
 If your planned budget includes administrative costs of more than 5%, then you must complete and
submit item 21.
 If your most recent prior-year grant award included a waiver of the administrative cap, then you must
complete and submit item 22.
Parent Committee Requirements
 If you are not a Bureau of Indian Education entity or a tribe applying in lieu of an LEA(s), then you must
complete and submit item 25. This item must be signed by representatives of the Parent Committee and
submitted with your application.
 If you are a Bureau of Indian Education entity or a tribe applying in lieu of an LEA(s), then you do not
need to complete and submit item 25.
 The Parent Committee form must be received on or before the EASIE Part II deadline to be considered
eligible for funding.
Comments to the Office of Indian Education
 Item 26 is available to any applicant that wishes to provide brief explanatory information about their
application.
Please be certain to complete all required items and to include all required forms in your submission
package. Also be sure to provide a copy to your state education agency, as specified in the general
instructions on p. 3 and to keep a file copy for yourself.
Item-by-Item Instructions. Instructions for each item are contained in the form. Consult the FAQ document for
additional explanatory information. To access the FAQ document, go to the main page of EASIE and click on
Getting Started. The first page of Getting Started provides a button to download the FAQ document. If you don’t
have access to the Internet, you can obtain the FAQ document by calling the Partner Support Center; see contact
information provided on p. 2 of this application package.

This application contains a very limited amount of free narrative response. Where you are asked to select items
from a list to enter into a table, please use only those items. Other responses will not be accepted.

Application for SY 2013 – 142014-15 Funds Under the
Indian Education Formula Grants to Local Educational Agencies
Part II

PROJECT IDENTIFYING INFORMATIONSECTION 1: GENERAL APPLICATION INFORMATION

Formatted: Font: 12 pt

1. PROJECT IDENTIFYING INFORMATION

Formatted: Font: 10 pt

Please fill in the following information:
Applicant Name:
DUNS #
PR #
Address:
Contact Name:
Telephone:
E-mail:

Allocation:
Allocation was based on student count of:

12. Application Type. Identify the type of application you are submitting for SY 2013 – 142014-15
(check exactly one):
___ Regular formula grant program (complete items 1 – 20b; complete items 21 and/or 22 if they apply for a
waiver; and complete item 25 unless you are a school funded by the Bureau of Indian Education or a
tribe applying in lieu of an LEA; complete item 26 if needed.)
___ Formula grant project consolidated with a Title I school-wide program (complete items 1-58, 10, 19,
and 20and 18-20b; complete item 25 unless you are a school funded by the Bureau of Indian
Education or tribe applying in lieu of an LEA; complete item 26 if needed.)
___ Integration of services under ESEA section 7116 (complete items 1-58, 18-20b 10, 19, 20, 23, and
24; complete item 25 unless you are a school funded by the Bureau of Indian Education or a tribe
applying in lieu of an LEA; complete item 26 if needed.)
2. Award start date. The date for your SY 2013 2014 – 14515 grant award to begin is July 1, 20132014.
The end date of the award period will automatically be June 30, 20142015.

Formatted: Left, Numbered + Level: 1 +
Numbering Style: 1, 2, 3, … + Start at: 1 +
Alignment: Left + Aligned at: 0.25" + Indent
at: 0.5"

LEA ASSESSMENT INFORMATION
Formatted: No Spacing, Centered

Complete items 3 – 8 for each LEA participating in your project. If your project includes only one LEA,
then use the forms below. If your project includes multiple LEAs, then duplicate the forms for items 3-8
and complete a set for each LEA. In this case, write the name of the LEA at the top of each page that
contains data for that LEA.
3. Identify the LEA.
Name:______________________________________________________________________
City: _______________________________________________________________________
State:__________________
NCES Number:______________________________
DUNS Number:______________________________
Check here if this is the lead LEA of a consortium:

Formatted: No Spacing, Centered, Space
After: 0 pt

Formatted: No Spacing, Centered

43. Grades Offered in SY 2011 2013 – 142. Indicate the grade levels offered by this LEA. Check all
that apply. Grades offered refers to the grades at which instruction is offered to students by the LEA or
BIE school. This is unrelated to whether any Indian students are in that grade or whether your Title VII
project will provide activities for that grade.
___PK ___K ___1 ___2 ___3 ___4 ___5 ___6 ___7 ___8 ___9 ___10 ___11 ___12

5. State Assessment Data for 2011 – 12. Provide the results for Indian students and all students in this
LEA for SY 2011 – 12 state assessments for all grades and subjects covered by state assessments.
This is unrelated to whether any Indian students are in that grade or whether your Title VII project will
provide activities for that grade or subject. Use the tables for which your state has assessments; if your
state does not assess in all of these subjects, then you will leave some tables blank. If your state does
not assess at every grade level, then you will leave some rows blank. Use a zero to indicate that no
students in your LEA were assessed or that no students were proficient; do NOT use a zero where your
state did not give an assessment.
In the tables that follow, the number of students “assessed” should include ONLY those students who
completed the assessment and had a valid score. If a student left the test in the middle, or for some
reason his assessment could not be scored (was lost or mutilated or any other reason), then that student
should not count as a student who was assessed.

Section 2: Coordination of Services for American Indian/Alaska Native Students

Formatted: Font: 12 pt
Formatted: Centered

54. Coordination of Services with Formula Grant Programs.
Please indicate which of the following LEA programs: [a] were available in your district during the last
school year (2013-2014); and [b] if that program is currently coordinated with Title VII services.

Programs

[a] Is this
program
available?
YES

NO

[b] Is this
program
coordinated
with Title VII
services?
YES
NO

Department of Education Formula Grant Programs
Title I
Homeless Children and Youth
Title III: English Language Acquisition
School Improvement Grants
Rural and Low-Income School Program
Impact Aid
Migrant Education
Other:
Other:
Other Federal, tribal, State, or local Programs (please specify):
BIE: Johnson O'Malley
Other:
Other:

565.. Description of Coordinated Services for American Indian/Alaska Native Students.
Each application must include a description of the applicant’s comprehensive program for meeting the
culturally related academic needs of Indian children, including their language and cultural needs.
Describe how the Coordination of Services for AI/AN Students (using a variety of funding sources)
will meet the needs of AI/AN students, including their language and cultural needs with an
explanation of specific programs and activities. In your explanation, also include programs from the
chart above in item 4 (Coordination of Services with Formula Grant Programs) that currently
coordinate with your Title VII project, or which will coordinate with Title VII during the grant year.
Enter narrative response here…(Please limit to 1,000 characters):

LEA Name: ________________________________________

a
Grade

SY 2011 – 12 Mathematics State Assessment Results for This LEA
b
c
d
e
f
Total number of
American
Indian and
Alaska Native
students
assessed*

Number of
American
Indian and
Alaska Native
students who
scored
Proficient or
Above

% Proficient or
Above of
American
Indian and
Alaska Native
students
(col c  col b) x
100

Total number of
all students
assessed*

Number of all
students who
scored
Proficient or
Above

g
% Proficient or
Above of all
students.
(col f  col e) x
100

PK
K
1
2
3
4
5
6
7
8
9
10
11
12

SY 2011 – 12 Reading (Language Arts/English) State Assessment Results for This LEA
a
b
c
d
e
f
g
Grade

Total number of
American
Indian and
Alaska Native
students
assessed*

Number of
American
Indian and
Alaska Native
students who
scored
Proficient or
Above

% Proficient or
Above of
American
Indian and
Alaska Native
students
(col c  col b) x
100

Total number of
all students
assessed*

Number of all
students who
scored
Proficient or
Above

% Proficient or
Above of all
students.
(col f  col e) x
100

PK
K
1
2
3
4
5
6
7
8
9
10
11
12
* Definition. Number of students “assessed” should include ONLY those students who completed the assessment and had a valid
score. If a student left the test in the middle, or for some reason his assessment could not be scored (was lost or mutilated or any
other reason), then that student should not count as a student who was assessed.

LEA Name: ________________________________________

a
Grade

SY 2011 – 12 Writing State Assessment Results for This LEA
b
c
d
e
f
Total number of
American
Indian and
Alaska Native
students
assessed*

Number of
American
Indian and
Alaska Native
students who
scored
Proficient or
Above

% Proficient or
Above of
American
Indian and
Alaska Native
students
(col c  col b) x
100

Total number of
all students
assessed*

Number of all
students who
scored
Proficient or
Above

g
% Proficient or
Above of all
students.
(col f  col e) x
100

PK
K
1
2
3
4
5
6
7
8
9
10
11
12

a
Grade

SY 2011 – 12 Science State Assessment Results for This LEA
b
c
d
e
f
Total number of
American
Indian and
Alaska Native
students
assessed*

Number of
American
Indian and
Alaska Native
students who
scored
Proficient or
Above

% Proficient or
Above of
American
Indian and
Alaska Native
students
(col c  col b) x
100

Total number of
all students
assessed*

Number of all
students who
scored
Proficient or
Above

g
% Proficient or
Above of all
students.
(col f  col e) x
100

PK
K
1
2
3
4
5
6
7
8
9
10
11
12
* Definition. “Number of students assessed” should include ONLY those students who completed the assessment and had a valid
score. If a student left the test in the middle, or for some reason his assessment could not be scored (was lost or mutilated or any
other reason), then that student should not count as a student who was assessed.

LEA Name: ________________________________________
6. Attendance for SY 2011 – 12. Provide average daily attendance figures for this LEA. Average daily
attendance for all students is required. Average daily attendance for Indian students is required if you
select attendance as an objective for your project; (you will select objectives in item 9).
Definitions. (See the FAQs for calculations. ADA is not a percentage.)
(1) Average Daily Attendance (ADA) - The average number of students in daily attendance computed
according to state law or regulation, or if no state definition exists, the aggregate number of days of
attendance by students divided by the number of days of enrollment of students during the reporting
period.
(2) Average Daily Attendance of Indian Students - The average number of Indian students in daily
attendance computed according to state law or regulation, or if no state definition exists, the aggregate
number of days of attendance by students divided by the number of days of enrollment of students
during the reporting period.

Average daily attendance for all students: _____________
Average daily attendance for Indian students: ___________

7. Graduation Data for SY 2011 – 12. Provide graduation rates for this LEA. Graduation rates for all
students and for Indian students are required if your LEA offers grade 12. Enter the value as a
percentage to one decimal place (e.g. 57.4%).
Definitions.
(1) Graduation Rate for All Students - The percentage of students who graduated from high schools
with a regular diploma. The calculation of the percentage rate is defined in the state’s accountability
plan in accordance with Title I, Section 200.19.
(2) Graduation Rate for Indian Students - The percentage of Indian students who graduated from high
schools with a regular diploma. The calculation of the percentage rate is defined in the state’s
accountability plan in accordance with Title I, Section 200.19.

Graduation rate for all students: ____________
Graduation rate for Indian students: _____________

LEA Name: ________________________________________
8. Non- ESEA Assessment Data for 2011 – 12. Provide the results for Indian students and all students
in this LEA on Non-ESEA SY 2011-12 assessments; this may be required as explained in the next
paragraph.

Formatted: Right: 0"

In item 9 of this application, you will be asked to set objectives for your project. If you decide to select
mathematics, reading, science, attendance, and/or graduation as objectives, then your progress will be
measured by the ESEA assessment data that you entered in items 4-7. If you decide in item 9 to select
any other objectives (non- ESEA objectives such as technology or dropouts), then you must complete this
table for each LEA for each objective to provide assessment data that can be used to measure your
progress. For any row you enter data, you must provide the information for both Indian students and all
students.
Permissible values. For each row of the table, write the code for the objective in column a, write the code
for the assessment source in column b, and write the grade level in column c. Choose these from the
following table of permissible values. Use only values in the chart; do not use any other values.
Permissible Values for Table 8
For each row, choose one of
these for column a.
DO = Dropout
Hist = History
Math = Mathematics
Rdg = Reading/language arts/ English
SS = Social Studies
Subs = Subtance Abuse
Tech = Technology
Wr= Writing
O = Other

Formatted: Left

For each row, choose one of these for
column b

For each row, choose one of
these for column c

Formatted: Left

CD = Curriculum Designed Tests
EOC = End-of-Course Exams
Exit = High School Exit Exam
Stnd = LEA-Selected Standardized Test
Port = Student Portfolios
O = Other Formal Assessment
Base = This is a first year objective; we will
collect baseline data this year.

PK
K
1
2
3
4
5
6
7
8
9
10
11
12

Formatted: Indent: Left: 0"

(If you select “Other” enter “Other” in column
“a” of a row and also specify the topic of that
objective in in the item immediately above the
table.)

Formatted: Indent: Left: 0", First line: 0"
Formatted: Indent: Left: 0", First line: 0"

Formatted: Indent: Left: 0", First line: 0"

Enter whole numbers into columns d, e, g, and h.
Enter percents rounded to a whole number in columns f and i.
Use a different row for each grade level of each assessment that you wish to report.
If you select “Other” as an objective, specify that objective here: _________________________________

Grade

Source

Objective

SY 2011 – 12 Other Assessment Information for This LEA
a
b
c
d
e
f
Total number
of American
Indian and
Alaska Native
students
assessed

Number of
American
Indian and
Alaska Native
students who
scored
Proficient or
Above

% Proficient or
Above of
American
Indian and
Alaska Native
students
(col e  col d)
x 100

Formatted: Left

g

h

i

Total number
of all students
assessed

Number of all
students who
scored
Proficient or
Above

% Proficient or
Above of all
students.
(col h  col g)
x 100

Formatted: Left
Formatted: Indent: Left: 0", Right: 0"

If you need more rows, you may duplicate this table.

Section 3: Indian Education Project Description
Applicants submitting as a Title VII project consolidated with a Title I school-wide program should skip
to Section 4
Applicants submitting under section 7116 (Integrated Services) should skip items 9 and 10 and go to
9aitem 23.

96. Indian Education Formula Grant Objectives.
Identify your specific project objectives towards the goal of providing culturally-responsive
education for AI/AN students to meet their academic needs and help them meet State
achievement standards. The objectives listed in the table align to the allowable activities and
services as specified in Section 7115(b) of the ESEA.
Permissible Values for Item 96
Objective: The goal of providing culturallyresponsive education for AI/AN students to meet
their academic needs and help them meet State
achievement standards.

 Increase school readiness
 Increase integration of Indian specific
content into curriculum
 Increase academic achievement
 Increase knowledge of cultural identity
and awareness
 Enhance problem solving and
cognitive skills development
 Increase school attendance rate
 Decrease school dropout rate
 Increase graduation rate
 Increase career readiness skills (e.g.,
technology skills, leadership skills)
 Increase college enrollment
 Increase substance abuse prevention
 Increase parent participation

Column a
Type(s) of supplemental activity or service
















Culturally-responsive early childhood
programs and activities
Culturally-responsive professional
development
Curriculum development integrating
local knowledge, language and
culture
Indian education (e.g., language,
history)
Cultural enrichment (e.g., events,
field trips, clubs)
Culturally-responsive academic
support (e.g., study skills, homework
support)
o overall
o in reading or ELA
o in mathematics
o in science
o in other subjects (e.g., social
studies)
Culturally-responsive academic
enrichment (e.g., after school
programs, projects)
College preparation (e.g., ACT or
SAT preparation, exploration,
advanced placement classes or
testing)
Career preparation (e.g., technology
skills, internships)
Gifted and talented programs
Student advocacy or leadership
Culturally-responsive mentoring

Column b
Grade levels served by
activity or service

 Pre-K
 Elementary
school grades
 Middle school
grades
 High school
grades

Objective: The goal of providing culturallyresponsive education for AI/AN students to meet
their academic needs and help them meet State
achievement standards.

Column a
Type(s) of supplemental activity or service






Column b
Grade levels served by
activity or service

Substance abuse prevention
Culturally-responsive counseling
Family literacy with culturally-based
materials
Parent involvement

Instructions for completing the table:
(1) Complete a separate table for each objective. You must have at least one objective;
however, you may have several.
(2) Select a permissible value for each objective.
(3) In column a, identify each activity or service that will be used to address the objective.
Use a separate row for each activity or service.
(4) In column b, identify the grade levels to be served by each activity or service.
Item 96 Proposed Project Objectives for SY 2014 – 15
Objective #1:

Column a
Type(s) of activity or service

Column b
Grade levels served by activity or
service

Item 6 Proposed Project Objectives for SY 2014 – 15
Objective #2:

Column a
Type(s) of activity or service

Column b
Grade levels served by activity or
service

107. Program Objectives Data Sources. Use this section to describe how you will measure
progress on each of the objectives.
Permissible Values for Item 107




Column a.
Objective
Increase school readiness
Increase integration of Indian specific
content into curriculum


Increase academic achievement

Increase knowledge of cultural identity
and awareness

Enhance problem solving and cognitive
skills development

Increase school attendance rate

Decrease school dropout rate

Increase graduation rate





Increase career readiness skills (e.g.,
technology skills, leadership skills)
Increase college enrollment
Increase substance abuse prevention
Increase parent participation



















Column b.
Data source
School readiness screening
Documents (e.g., lesson plans, curriculum)
State standardized test
District benchmark assessment
Other standardized achievement test
Non-standardized achievement test
Student portfolios
Teacher surveys, interviews, or focus groups
Classroom observations
Parent surveys, interviews, or focus groups
Student surveys, interviews, or focus groups
Administrator surveys, interviews, or focus groups
Attendance data
Dropout data
Graduation data
College application and acceptance data
Other data source – If you select “Other data source” enter
“Other data source” in column b of a row and also specify the
data source

I

I
I

E

I
D
I
I

Instructions for completing the table:
(1) In column a, identify the objectives chosen in item 8a. Use a separate row for each
objective.
(2) In column b, identify the data source(s) for each objective in column a. Identify at least
one data source for each objective. If you identify more than one data source for an
objective, use a new row for each objective and data source combination.
Formatted: Indent: Left: 0.5", No bullets or
numbering
I

(3)
Item 7 Data Sources
Column a
Objective

Column b
Data source

Formatted: No bullets or numbering

Formatted: Left

PROJECT DESCRIPTION
Complete items 9 and 10 for your project (not separately for each participating LEA). The information you
enter applies to the entire project including all participating LEAs.
9. Objectives for SY 2013 – 14. Determine your project objectives for SY 2013 – 14. Complete a
separate table for each objective. You must have at least one objective; you may have several.
Note: Applicants submitting as a Title VII project consolidated with a Title I schoolwide program should skip item 9. Applicants
submitting under section 7116 (Integrated Services) must complete item 23 in lieu of item 9.

Permissible values
Choose a permissible value (from the chart below) for your first objective. Enter it into row 1 of you r table.
In row 2 of your table, check the grade levels which you will target for this objective.
In column a of the remaining rows of that table, enter one of the services listed below that you will offer for
the purpose of improving results on this objective.
In columns b-d for that row, enter the frequency, location, and activity of that service, choosing in each
case from the values in the chart below. Use only the values in the chart; do not enter other values.
Fill in as many rows as needed to represent all of the services you will provide in support of improving
results on that objective. You must complete at least one row.
If you choose to have additional objectives, fill in a table for each objective, as described above.
If you selected any objectives other than attendance, graduation, mathematics, reading, or science,
review item 8 to ensure that you have provided assessment data for each LEA for each objective.
Permissible Values for Table 9
Permissible
Permissible Column a, b, c, and d Values
Row 1 Values
Row 1: Objective.
Pick one and only
one for each table.

Col. a: Service
Pick one and only one for
each row of your table.

Col b: Frequency
Pick one and only
one for each row of
your table.

Col c: Location
Pick one and only one
for each row of your
table.

Col d: Activity
Pick one and only one for
each row of your table.

Attendance
Dropout
Graduation
History
Mathematics
Reading
Science
Social Studies
Substance Abuse
Technology
Writing
Other

Attendance
Dropout Prevention
Language Arts and/or Writing
Literacy: Family
Mathematics: Accelerated
Mathematics: Intervention
Native American Studies
Native Language Instruction
Pre-Advanced Placement (AP)
Preparation
Reading: Accelerated
Reading: Enhancement and
Writing
Reading: Family Literacy
Reading: Intervention
Reading Recovery Program
Reading: Success for All
School Readiness
Science
Social Studies
State or End-of-Course Exam
Preparation
Substance Abuse Prevention
Technology: Use and
Proficiency
Tribal History

Before School
After School
Grading Periods
Semester
Tri-Semester
Evenings
Weekends
Daily
Four Times a Week
Three Times a Week
Twice a Week
Once a Week
Bi-Weekly
Three Times a Month
Twice a Month
Once a Month
Quarterly
Year Round
Summer
Special Events

Camps
Chapter House
Community Centers
Historical Sites
In Class
LEA Office/Region
Other Organizational
Designated Sites
Pull-outs
Residential Hall
School
Tribal Agencies/Offices
Tribal Facilities
University Campus

ACT or SAT Preparation and
Testing
Advanced Placement (AP)
Preparation
AP Coursework and Testing
Career and/or College Guidance
Civic Projects
Counseling
Creative Writing
Credit Recovery or Completion
Experiential Learning
Libraries: Cultural Lending of
Materials
Multicultural Affairs or Events
Storytelling
Study Skills Development
Student Clubs with Academic
Emphasis
Tutoring: Skill Development
Individually
Tutoring: Skill Development in
Small Groups
Tutoring: Homework Assistance
Individually
Tutoring: Homework Assistance
in Small Groups
Youth Leadership: Groups or
Clubs

(If you select “Other”
as an objective, enter
“Other” in row 1 and
also specify the topic
of that objective in row
1)

Go to the next page for data entry tables in which to enter your objectives.

Your Project’s Objective for SY 2013 - 14
Objective #1: (fill from row 1 list)
Grades: (check all that apply)
___PK ___K ___1 ___2 ___3 ___4 ___5 ___6 ___7 ___8 ___9 ___10 ___11 ___12
a
b
c
d
(fill from column a list)

(fill from column b list)

(fill from column c list)

(fill from column d list)

Your Project’s Objective for SY 2013 - 14
Objective #2: (fill from row 1 list)
Grades: (check all that apply)
___PK ___K ___1 ___2 ___3 ___4 ___5 ___6 ___7 ___8 ___9 ___10 ___11 ___12
a
b
c
d
(fill from column a list)

(fill from column b list)

(fill from column c list)

(fill from column d list)

Your Project’s Objective for SY 2013 - 14
Objective #3: (fill from row 1 list)
Grades: (check all that apply)
___PK ___K ___1 ___2 ___3 ___4 ___5 ___6 ___7 ___8 ___9 ___10 ___11 ___12
a
b
c
d
(fill from column a list)

(fill from column b list)

(fill from column c list)

If you need additional tables for more objectives, you may duplicate this page.

(fill from column d list)

10.
8. Coordination of Services Professional Development.
Describe the professional development opportunities that will be provided by your coordination of
services to ensure that teachers and other school professionals who are new to the Indian
community are prepared to work with Indian children, and all teachers who will be involved in
programs assisted by this grant, have been properly trained to carry out such programs. The
professional development opportunity or opportunities can be funded using other local, State, and/or
federal funds. (The specific use of Indian Education formula grant funds will be detailed in Sections 3
and 4.)
Note: The professional development opportunity or opportunities identified in item 68 do not have to
be new opportunities or opportunities for which funding is requested. Applicants should include
existing professional development opportunities that will continue to be implemented in the school
year for which funding is requested, as long as those opportunities are components of the coordinated
services program.
Permissible Values for Item 68
Pick one of the following to enter
Pick one of the following to enter in
in column a
column b
(Types of staff)
(Type of professional development
activity)
 All teachers and other school
professionals
 Teachers and other school
professionals that are new to the
Indian community
 Subset of teachers (please
identify or describe how this
group is defined)
 LEA staff (example, Title VII
coordinators)
 Other non-teaching staff
(examples: counselors, Parent
Committee)

 Workshops/Sessions
 Conferences, including national,
regional, state, or LEA-sponsored
 Pre-service training or orientation
 School-based coaching or mentoring
 Other (example: online courses,
webinars, Tribal Agency training)--if
you select “Other” as a professional
development activity, enter “Other” in
column b of a row and also specify the
activity there.

Pick one of the following to enter in
column c
(Content)
 Integrating Indian- specific content into
the general curriculum
 Indian Education-specific
(example: instruction specific to
language or specific Indian
curricula)
 Cultural Awareness Education and
Sensitivity (example: working with Indian
students)
 Use of Data/ Data-driven decision
making (example: examining
patterns in Indian Student test data;
using data to focus instruction for AI
students; identification of exceptional
students)
 Impact of district policies on AI students
(example: grading policies, attendance
policies, discipline, suspensions, etc.)
 Other--if you select “Other” as
content, enter “Other” in column
c of a row and also specify the
content there.

Instructions for completing the table:
(1) Using permissible values, enter the types of staff that will be served by professional development
activities to support the coordination of services program in column a. Use a new row for each
type of staff.
(2) Using permissible values, in column b enter the type of professional development activity that
each type of staff identified in column a will receive.
(3) Using permissible values, in column c enter the content of each professional development activity
entered in column b.
Item 68
Coordination of Services Program Professional Development Activities for SY 2014 – 15
Column b
Column c
Column a
Type of professional development
Content
Types of staff
activity

You may duplicate this table, as needed.
Professional Development in Support of Your FY 2013 – 14 project. Identify the professional
development opportunities planned using grant funds.
Permissible values. For each row of the table, write in the type of staff in the first column and the type of
opportunity in the second column. Choose these from the following table of permissible values. Use only
values in the chart; do not use any other values.
Permissible Values for Table 10
Pick one of the following to enter in column a.
Project staff
Teachers and Other School Professionals
All LEA staff

Pick one of the following to enter in column b
Assessments and Related Training
LEA-Required Training
Multi-cultural Education and Sensitivity
National Educational Conferences
OIE-sponsored Workshops/Sessions
Orientation on Working with Indian Students
Other Conferences Related to Indian Education
Program Objective-specific and Related Training
Regional Educational Conference
Standards-based Related Training
State-sponsored Session or Conferences
Subject-specific and Related Training
Other
(If you select “Other” as a professional development opportunity, enter
“Other” in column b of a row and also specify the opportunity there.

Your Project’s Planned Professional Development for SY 2013 – 14
a
B
Staff
Professional Development Opportunity

SECTION 4: BUDGET INFORMATION
Complete the budget section for your project (not separately for each participating LEA). The budget
must match the objectives you selected for items in section 3. The information you enter covers the
entire project including all participating LEAs.
Total costs in your budget cannot exceed your allocation. If your administrative costs exceed 5% of your
allocation, you must reduce those costs to less than 5%, or complete the waiver request form (item 21
and 22).If your administrative costs exceed 5% of your allocation, you must complete the waiver request
form (item #21)
Note: Applicants submitting as a Title VII project consolidated with a Title I schoolwide program should skip Section 4.items 11 –
18. Applicants submitting under section 7116 (Integrated Services) must complete item 23 in lieu of items 11 – 18.

119. Supplemental Information.
□ By checking this box, I will ensure that the Indian Education formula grant funds will supplement and not
supplant other funding for the education of Indian children, with the goal of providing culturallyresponsive education to meet the academic needs of AI/AN students and to assist those students in
meeting State achievement standards. See FAQs for guidance and examples.
1110. Personnel Budget. Complete the table for personnel to be funded by the project.
Permissible values. Complete rows 1 and 2a-g (Project Director and Project Coordinator) as they are
applicable. Complete additional rows for each type of personnel at each certification status and each
percentage of time. [Example, if you have some academic advisors who work 20% time on the project
and other academic advisors who work 30% time on the project, you would need to complete two rows for
academic advisors.]
Choose values for columns a and b from the following table of permissible values.
Permissible Values for Table 11.
For each row, pick one of the following values for
For each row, pick one of the following values for
column a.
column b. Use the abbreviation.
Academic Advisors
Cert = Certified
Administrative Assistants
NC = Not Certified
College instructors
Consultants
Counselors, Guidance
Counselors, Mental Health
Cultural Resource Specialists
Curriculum Specialists
Data Specialists
Home/School Coordinators
Instructional Assistants
Language Instructors
Liaisons, Home/School or Community
Nutrition Specialists
Reading Coaches or Specialists
Social workers
Support, Clerical or Secretarial
Teachers
Tribal Elders
Youth Development Specialists
Other

(If you select “Other”, enter “Other” in column a of a row
and also specify the personnel type it represents.

For each row, enter in column bc the number of personnel in this group; enter in column d c the percent
of time that group of personnel will be assigned to and funded by the project; enter dollar values in
columns e, f, and gd,e and f; enter in column h g the sum of the values for columns e, f, and gd, e, and f
for that row. Use as many rows as necessary.
On the last row of your table, enter the column totals for columns c, e, f, g, and hd, e, f, and g..

Certification
status

Your Project’s Personnel Budget for SY 2013 – 142014-15
a
b
cb
dc
ed
fe
gf
hg
Type of Personnel
#
% of
Admin Program Fringe
Total
time
Cost ($) Cost ($) Cost ($) Cost ($)

Project Director
Project Coordinator

Category Subtotals

1211. Travel Budget. Complete the table for travel to be funded by the project.
Enter the dollar value for each type of travel. Enter row and column totals.
Your Project’s Travel Budget for SY 2013 – 142014-15
Type of Travel
Admin Cost ($)
Program Cost ($)
In-district (non-PD)
Out of district (non-PD)
Professional development
(only)
Category Subtotals

Total Cost ($)

1312. Equipment Budget. Complete the table for equipment to be funded by the program (defined as a
single item with value exceeding $5,000).
In column a, identify the item in your own words.
In column b, enter the code to identify the purpose as one of the following:
Instr = Instructional Service Delivery
Prog Mgmt = Program Management
In columns c and d, enter dollar values.
Use as many rows as necessary.
Enter row and column totals.

a
Item

Your Project’s Equipment Budget for SY 2013 – 142014-15
b
c
d
e
Purpose
Admin Cost ($) Program Cost ($) Total Cost ($)

Category Subtotals
1413. Supplies Budget. Complete the table for supplies to be funded by the project.
Enter the dollar value for supplies of each listed type. Note that Direct Instructional Materials and Student
Consumables have no administrative cost. Enter row and column totals.
Your Project’s Supplies Budget for SY 2013 – 142014-15
a
b
c
Item
Admin Cost ($)
Program Cost ($)
Direct Instructional Delivery
Student Consumables
Program Management
Category Subtotals

d
Total Cost ($)

Formatted Table

1514. Contractual budget. Complete the table for contractual services to be funded by the project.
Enter the dollar value for contractual services for each listed purpose. Note that Direct Instructional
Materials and Student Consumables have no administrative cost. If you use the row for “Other”, describe
the expense in the column a. Enter row and column totals.
Your Project’s Contractual Budget for SY 2013 – 142014-15
a
b
c
d
Purpose
Admin Cost ($)
Program Cost ($)
Total Cost ($)
Direct instructional delivery
Student evaluations
Program management
Other. Specify:
Category subtotals

1615. Other Budget. Complete the table for other expenses to be funded by the project.
Enter the dollar value for other expenses for each listed purpose. Note that Direct Instructional Materials,
Student Activities Related to Services, and Student Consumables have no administrative cost. If you use
the row for “Other”, describe the expense in the column a. Enter row and column totals.
Your Project’s Other Budget for SY 2013 – 142014-15
a
b
c
Purpose
Admin Cost ($)
Program Cost ($)
Direct Instructional Delivery
Student Activities Related to
Services
Student Consumables
Program Management
Professional Development
(non-travel related)
Other. Specify:
Category subtotals

d
Total Cost ($)

1716. Indirect costs. Enter your entity’s restricted indirect cost rate. The rate should be entered as a
percent and may have up to two decimal places (e.g. 27.234.08%). If you choose to budget project funds
for indirect costs, enter the total amount of indirect costs associated with the project. You are entitled to
budget indirect costs from your Title VII allocation up to a maximum of your indirect cost rate times your
allocation. You can budget a lesser amount of your indirect costs from your Title VII allocation. You do
not have to budget for indirect costs. In that case, you may leave the table blank.

Formatted: Underline

Your Project’s Indirect Costs for SY 2013 – 142014-15
Rate (%)
Total ($)

18a17a. Budget Summary. Transcribe the “category total” from each budget category to column b of
this summary table. The “category total” is the value in the bottom right-hand cell of each category table.
Be sure that the values in the summary table match the values in the category tables. Enter the percent
for each row and enter column totals.
Your Project’s Budget Summary for SY 2013 – 142014-15
a
b
c
Budget Category
Category Subtotal
Percent of Overall Allocation
Personnel
Travel
Equipment
Supplies
Contractual
Other
Total Direct Charges
Indirect Costs
Total Costs

Formatted: Right

18b17b. Administrative Costs Summary. Administrative costs cannot exceed 5% of your grant award.
Transcribe the category subtotals for administrative costs to column b in the following table. The category
subtotals for administrative costs are found as the last row of the administrative cost column of each of
the budget category tables except indirect cost. Be sure the values in the administrative cost summary
table match the values in the category tables. In the last row, enter the total Administrative Cost in
column b. In column c, enter the percent calculated as the last row of column b divided by the LEA’s total
allocation for the Indian Education formula grant for SY 2012 – 132014-15.
Your Project’s Administrative Cost Summary for SY 2013 – 142014-15
a
b
c
Budget Category
Administrative Cost
Percent of Overall Allocation
Category Total
Personnel
Travel
Equipment
Supplies
Contractual
Other
Totals
If the value in the last row of column c is more than 5%, then you are required complete and submit the
waiver request (item 21).
Formatted: Left

SECTION 5: OTHER PROJECT INFORMATION REQUIRED OF ALL APPLICANTS
1918. Dissemination and Use of Assessment Data. Provide information on how the state assessment
data of all Indian students (not just those served) are used. Inidcate how you plan to disseminate
information to the Indian community and Parent Committee. Check all that apply. All applicants must
respond to theseis items.
Timeframe last assessment(s) was conducted: SY 2011 – 12
Method of dissemination to Indian community and Parent Committee:
___ Public hearing for application
___ Parent Committee meeting
___ Other open meeting
___ Within a written report
___ Posted on website
___ Sent home with student(s)
___ Radio broadcast
___ Newsletter
19. Additional Assessment Data Use. How are the LEAs responding to findings of previous
assessment(s)Indicate how assessment data from the previous school year were used (check all that
apply)
___ No changes in services/programs
___ Modification to services/programs at LEA level Describe: ___________________________
___ Modification to services/programs within project Describe: ___________________________
20a. Program Assurances. The following are the program assurances that are referenced in item 20b
and to which the applicant LEA must agree. The signature of the authorizing official in item 20b will
indicate agreement to these provisions.
Additional Program Assurances for 84.060 - Indian Education Formula Grants
1.

If the applicant is an LEA, it assures that funds received under this program will be used only to supplement
the level of funds that, in the absence of the Federal funds made available under this program, the LEA
would make available for the education of Indian children, and not to supplant such funds. (Section
7114(c)(1) of Part A, Title VII)

2.

It assures that it will submit a performance report, or, for the last year of a project, a final report, that
evaluates at least annually: (a) the grantee's progress in achieving the objectives in its approved
application; (b) the effectiveness of the project in meeting the purposes of the program; and (c) the effect of
the project on participants being served by the project. (34 CFR 75.590)

3.

It assures that it will cooperate in any evaluation of the program by the Secretary. (34 CFR 75.591)

4.

It assures that the program for which funds are sought is based on a comprehensive local assessment and
prioritization of the unique educational and culturally related academic needs of the American Indian and
Alaska Native students for whom the LEA is providing an education. (Section 7114(c)(3) of Part A, Title VII)

5.

It assures that it will use the best available talents and resources, including persons from the Indian
community. (Section 7114(c)(3) of Part A, Title VII)

6.

It assures that it has developed the project for which application is made (a) in open consultation with
parents of Indian children and teachers and, if appropriate, Indian students from secondary schools,
including through public hearings held to provide a full opportunity to understand the program and to offer
recommendations regarding the program; and (b) with the participation of a parent committee selected in
accordance with section 7114(c) of the statute; and (c) with the written approval of that parent committee.
(Section 7114(c)(3)(4) of Part A, Title VII)

Formatted: Font: Bold

7.

8.

It assures, if it is a local educational agency, that the parent committee will adopt and abide by reasonable
by-laws for the conduct of the activities of the committee. (Section 7114(c)(4) of Part A, Title VII)

8. It assures that the LEA has established policies and procedures, including policies and procedures relating to
the hiring of personnel, that will ensure that the program will be operated and evaluated in consultation with,
and with the involvement of, parents of the children, and representatives of the area, to be served. (Section
7114(c)(4)).
8.

It assures that the policies and procedures, and sets forth such policies and procedures, including policies
and procedures relating to the hiring of personnel, will ensure that the program will be operated and
evaluated in consultation with, and with the involvement of, parents of the children, and representatives of
the area, to be served. (Section 7114(c)(4) of Part A, Title VII)

9.

It assures that an application for inclusion of these program funds in a Title I school-wide project, has been
approved, in writing, by the parent committee and that the parent committee was allowed to review the
application in a timely fashion, has determined that the program will not diminish the availability of culturally
related activities for American Indians and Alaska Native students, and has determined that the Title I
schoolwide project meets the purpose of the Indian education formula grant program. (Sections
7114(c)(4)(D) and 7115(c) of Part A, Title VII)

10. It assures that it will directly administer or supervise the administration of the project. (34 CFR 75.701)
11. It assures that it will keep records related to grant funds, program compliance and program performance and
will afford the Secretary access to these records as the Secretary may find necessary to assure the
correctness and verification of reports made by the applicant. (34 CFR sections 75.730-.732)
12. It assures that it has fiscal control and fund accounting procedures that insure proper disbursement of and
accounting for Federal funds. (34 CFR 75.702)
13. Pursuant to Section 9306(a) of the Elementary and Secondary Education Act, it assures that:


The program will be administered in accordance with all applicable statutes, regulations, program plans,
and application;



The control of funds provided under the program and title to property acquired with program funds will
be in a public agency or in a nonprofit private agency, institution, organization, or Indian tribe, if the law
authorizing the program provides for assistance to those entities and who will administer these funds
and property to the extent required by the authorizing statute;



The applicant will adopt and use proper methods of administering the program, including -- the
enforcement of any obligations imposed by law on agencies, institutions, organizations, and other
recipients responsible for carrying out the program; and the correction of deficiencies in program
operations that are identified through audits, monitoring, or evaluation;



The applicant will cooperate in carrying out any evaluation of the program conducted by or for the State
educational agency (SEA, if the applicant is an LEA), the Secretary or other Federal officials;



The applicant will use fiscal control and funds accounting procedures that will ensure proper
disbursement of, and accounting for, Federal funds paid to the applicant under this program;



The applicant will make reports, maintain records, provide information, and afford access to the State
educational agency and the Secretary as may be necessary to enable the SEA, for LEA applicants,
and the Secretary to carry out and perform their duties under this program; and



Before the application is submitted, the applicant affords a reasonable opportunity for public comment
on the application and has considered those comments.

20b. Certification. An authorized official must certify as follows.
The applicant certifies by clicking the appropriate checkboxes that by accepting the award for the
Indian Education Formula Grant Program, this grantee will comply with all program assurances,
agrees to carry out the program and meet all applicable requirements described herein. A copy
of the Parent Committee Approval form (if applicable) is uploaded with this certification no later
than the EASIE Part II deadline.

Signature:________________________________
_________________________________________
Printed Name
Title
Title

________________
Date

SECTION 6: ITEMS REQUIRED FOR SOME APPLICANTS
21. Waiver Request. If your project’s administrative costs for SY 2013 – 142014-15 are budgeted at
more than 5% of your allocation, you must complete the following form.
Waiver Request for SY 2013–142014-15
Indian Education Formula Grant Program
The administrative costs associated with this application total ______%.
Under the authority of Section 9401, a waiver is requested of the following statutory requirement:
 Administrative cap of 5% on grant funds under the Indian Education Formula Grant
Program to Local Education Agencies (section 7115(d)).
This waiver is requested by:
LEA Name: __________________________________________________________
Mailing Address:_______________________________________________________
City/State/Zip_________________________________________________________

The waiving of this requirement will increase the quality of instruction for students by:

The waiving of this requirement will improve the academic achievement of students as follows:

The methods for measuring and evaluating the educational goals of the program are described within the accompanying
application for the Indian Education Formula Grant Program. Approval of this waiver will not affect the population to be
served by this application. The students to be served are those students certified as Indian according to the Indian
Student Eligibility Form (ED 506 form) and for whom the services of this project are targeted according to the project’s
objectives.
The duration of this waiver will be for a maximum period of one year.
Authorized signature: __________________________________

___________________________________________________
Printed Name:
Title:
Title:

________________________
Date

22. Waiver Use Report. If you received a waiver of the administrative cap for your prior year’s grant,
you must complete the following form.
Waiver Use Report
Indian Education Formula Grant Program

For the previous grant year, the following LEA received a waiver of the requirement restricting
the use of program funds for administrative purposes to 5%.
LEA Name: __________________________________________________________
Mailing Address:_______________________________________________________
City/State/Zip_________________________________________________________

Complete the following statements:
Under the waiver, the grantee
 Utilized ____% of the total funds for administrative purposes.
 Used these funds for administrative purposes to increase the quality of instruction to
students as follows:

 Is improving the academic achievement of students as follows:

23. Program Summary for Applications Under Section 7116, Integrated Services. This table is must
be completed by projects that submit a plan for the integration of education and related services provided
to Indian students under Section 7116 of the Elementary and Secondary Education Act, as amended.
Funds from any Federal program exclusively serving Indian children, or the funds reserved unde r any
Federal program to exclusively serve Indian children, received through a statutory or administrative
formula for the purposes of providing education and related services to serve Indian students, may be
consolidated in a demonstration project that integrates the program services involved into a single,
coordinated, comprehensive program and reduces administrative costs by consolidating administrative
functions.
Applicants submitting under this provision must complete the following table in lieu of table 9. List the
services to be provided, the entity providing the service, and the timeframe for service delivery.
Your Project Summary for a SY 2013 – 142014-15 Application Under Section 7116
a
b
c
Service(s) to be Provided
Entity Providing Service
Timeframe for Service Delivery

24. Budget Summary for Applications Under Section 7116, Integrated Services. This budget table
must be completed by projects that submit a plan for the integration of education and related services
provided to Indian students under Section 7116 of the Elementary and Secondary Education Act, as
amended. Funds from any Federal program exclusively serving Indian children, or the funds reserved
under any Federal program to exclusively serve Indian children, received through a statutory or
administrative formula for the purposes of providing education and related services to serve Indian
students, may be consolidated in a demonstration project that integrates the program services involved
into a single, coordinated, comprehensive program and reduces administrative costs by consolidating
administrative functions.
Applicants submitting under this provision must complete the following table in lieu of tables 11-18. List
the programs to be consolidated and the estimated amount of each.
Your Project’s Funding Summary for a SY 2013 – 142014-15 Application Under Section 7116
a
b
c
Program
Funding Agency
Estimated Amount

25. Parent Committee Approval. This item must be completed and submitted with LEA applications and LEA
consortium applications on or before the certification deadline by upload within the EASIE system, unless your
are approved to submit the form outside the EASIE system. The form must contain original signatures of the
required members of the Parent Committee (PC) for that applicant. The applicant and Parent Committee (PC)
are to locally determine the number of PC members that are required for PC approval of the application.
Please see the FAQs for more detail about this requirement.
Note: This form is not required of schools funded by the Bureau of Indian Education or a tribe that is applying in lieu of an LEA(s).

PARENT COMMITTEE APPROVAL OF A TITLE VII FORMULA GRANT PROGRAM
Elementary and Secondary Education Act, Title VII, Part A, Subpart 1

Name: ____________________________________
PR Award #: _______________________________
Address __________________________________

Check the type of application submitted.
Check only one box:
 Regular formula grant program
 Title I school-wide program
 Integration of Services (Section 7116)

City/State/Zip ______________________________
Additional Assurances (Check all that apply):


This certifies that the Parent Committee for the above entity has participated in the development of the application
for Title VII funds and approves the proposed project.



The application is for a regular formula grant project.



o

The Parent Committee has established bylaws.

o

The Parent Committee is composed of parents/guardians of Indian children in the local educational
agency's schools; teachers in the schools; and if appropriate, Indian students attending secondary
schools of the agency.

The application submitted will include project funds in a Title I school-wide program.
o

The Parent Committee determined that the program will not diminish the availability of culturally related
activities for American Indian and Alaska Native students.

o

The Parent Committee also certifies that it had an opportunity to review the program in a timely fashion
and it is consistent with the purpose of the formula grant program for American Indian and Alaska Native
students.

The written approval of the parent committee must be obtained before Part II closes and must be uploaded within the
EASIE system. The Parent Committee locally determines the number of PC members that are required for PC approval of
the application. Parent committee members’ signatures, titles and date are required.

_________________________________
Name
Date
Title: (Choose one)
 Parent/Guardian
 Teacher
 High School Student
 Other _______________________
___________________________________
Name
Date
Title: (Choose one)
 Parent/Guardian
 Teacher
 High School Student
 Other _______________________

Parent Committee Approval of a
Title VII Formula Grant Application
____________________________________________________________________

26. Comment.
Use the space below (limited to 1,000 characters) to provide additional information that will assist the
Department in analyzing your application.
If not needed for the above reasons this comment item can be left blank.
Use the space below (limited to 1000 characters) to provide additional information, including the following:
(a) If you selected “Other” from any permitted list, define it here if you did not have adequate space to define it
within the application forms.
(b) If needed, provide an explanation of any anomalies that will assist the Department in analyzing your
application.
If not needed for the above reasons, this comment item can be left blank.

Applicant Comment:

U.S. Department of Education
Office of Indian Education
SAMPLE Consortium Agreement
Formatted: Centered

For the purpose of applying for an Indian Education Formula Grant application as consortium members, we, the
undersigned local educational agencies (LEAs) agree to adhere to the requirements under 34 CFR §75.127–129
(attached). Each LEA also certifies that it is not submitting a separate application as an individual LEA for this
same grant. In addition,
1. General Agreement
It is agreed that the lead consortium member LEA will be
____________School District , which is
designated to act on behalf of all consortium member LEAs. As a consortium member we understand that this
agreement binds each member of the group to every statement and assurance made by the applicant in the
application. The applicant for the group is the grantee and is legally responsible for -(A)
The use of all grant funds;
(B)
Ensuring that the project is carried out by the group in accordance with Federal requirements; and
(C)
Ensuring that indirect cost funds are determined as required under 34 CFR §75.564(e).
2. Legal Responsibility
We also understand that, as an LEA member of the consortium, we are each legally and individually responsible
to -(A)
Carry out the activities we agree to perform; and
(B)
Use the funds that we receive under the agreement in accordance with Federal requirements that apply
to the grant, including the parent consultation and committee requirements below.
3. Parent Consultation and Committee requirements

(A)
The local program for which we seek funding (“Indian Education program”) was developed in open
consultation with parents of Indian children and teachers, and, if appropriate, Indian students from secondary
schools, including through public hearings held to provide individuals in each member LEA a full opportunity to
understand the program and to offer recommendations regarding the program.
(B)
[Each member LEA developed the Indian Education program with the participation and written
approval of a Parent Committee composed and selected in accordance with section 7114(c) of the ESEA, Title
VII, Part A]
Or
[The Indian Education program was developed with the participation and written approval of a Parent
Committee composed and selected in accordance with section 7114(c) of the ESEA, Title VII, Part A, including
parents from each member LEA proportionate to the school population of each LEA]
(C)
The Parent Committee has set forth such policies and procedures, including policies and procedures
relating to the hiring of personnel, as will ensure that the Indian Education program will be operated and
evaluated in consultation with, and with the involvement of, parents of the children in each LEA, and
representatives of the area, to be served.

4. Comprehensive Program
These grant funds will be used to carry out, in each member LEA, a comprehensive program for meeting the
needs of Indian children, including their language and cultural needs, consistent with ESEA section 7115 (20
USC 7425). The particular activities for this grant will be:
______________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
__________________________________________________________________________

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Signed by the following authorized representatives of the member LEAs:
(copy additional sign-off spaces as needed)

_______
Name and Title

_______
School District

_______________
Date

_______
Name and Title

_______
School District

_______________
Date

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_______
Name and Title

_______
School District

_______________
Date

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_______
Name and Title

_______
School District

_______________
Date

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_______
Name and Title

_______
School District

_______________
Date

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Group Applications: From Code of Federal Regulations (34 CFR Part 75)
§ 75.127 Eligible parties may apply as a group.
(a) Eligible parties may apply as a group for a grant.
(b) Depending on the program under which a group of eligible parties seeks assistance, the term used to
refer to the group may vary. The list that follows contains some of the terms used to identify a group of
eligible parties:
(1) Combination of institutions of higher education.
(2) Consortium.
(3) Joint applicants.
(4) Cooperative arrangements.
(Authority: 20 U.S.C. 1221e–3 and 3474)
§ 75.128 Who acts as applicant; the group agreement.
(a) If a group of eligible parties applies for a grant, the members of the group shall either:
(1) Designate one member of the group to apply for the grant; or
(2) Establish a separate, eligible legal entity to apply for the grant.
(b) The members of the group shall enter into an agreement that:
(1) Details the activities that each member of the group plans to perform; and
(2) Binds each member of the group to every statement and assurance made by the applicant in the
application.
(c) The applicant shall submit the agreement with its application.
(Authority: 20 U.S.C. 1221e–3 and 3474)
§ 75.129 Legal responsibilities of each member of the group.
(a) If the Secretary makes a grant to a group of eligible applicants, the applicant for the group is the
grantee and is legally responsible for:
(1) The use of all grant funds;
(2) Ensuring that the project is carried out by the group in accordance with Federal requirements; and
(3) Ensuring that indirect cost funds are determined as required under §75.564(e).
(b) Each member of the group is legally responsible to:
(1) Carry out the activities it agrees to perform; and
(2) Use the funds that it receives under the agreement in accordance with Federal requirements that
apply to the grant.
(Authority: 20 U.S.C. 1221e–3 and 3474)

U.S. Department of Education
Office of Indian Education
SAMPLE Agreement for Tribes Applying in Lieu of LEAs

Formatted: Font: 10 pt

For the purpose of applying for an Indian Education Grant application as a Tribe Applying in Lieu of a
local education agency (LEA), the LEA(s) agree(s) to adhere to the requirements under 34 CFR §75.127 129. The LEA also certifies that it is not submitting a separate application as an individual LEA for this
same grant. In addition,
1. General Agreement
It is agreed that ________________________ (tribal entity), will apply in lieu of ____________________
School District.
2. Legal Responsibility of the LEA
 The LEA has not established a parent committee according to Section 7114(c)(4).
 All of the Indian students identified by the tribe were enrolled in the LEA’s school(s) during the
count period indicated by the tribe.
3. Legal Responsibility of the Tribe applying in lieu of an LEA
 The tribe has a completed Indian Student Eligibility (ED 506) form on file at the time of the count.
 A list of students, by tribe, being counted for the purposes of this grant and the count period being
used by the tribe.
 The applicant Indian tribe represents no less than one-half of the eligible Indian children served
by the LEA.
The LEA certifies that the above count represents the number of eligible Indian students enrolled in its
school. It is understood that this count will be used to calculate an award of federal assistance and that is
subject to audit.
Signed by the following authorized representative of the member LEAs:
(Copy additional sign-off spaces as needed)
_________________________________
_____________
Name and Title

____________________________

_________________________________
_____________
Name and Title

____________________________

_________________________________
_____________
Name and Title

____________________________

School District

School District

School District

Date

Date

Date

The applicant tribe is responsible to carry out the activities agreed to perform; and use the funds received
under the agreement in accordance with Federal requirements that apply to the grant. Signed by the
following authorized representative of the tribe:
(Copy additional sign-off spaces as needed)
_________________________________
_____________
Name and Title

____________________________
Indian Organization

Date

_________________________________
_____________
Name and Title

____________________________

_________________________________
_____________
Name and Title

____________________________

Indian Organization

Indian Organization

Date

Date