2012-2013 Financial Assistance for Students with Intelle

OMB NO. 1845-0113
Expires: XX/XX/XXXX

2013-2014 Financial Assistance for Students with Intellectual Disabilities Expenditure Report

Award Year July 1, 2013 through June 30, 2014

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. Public reporting burden for this collection of information is estimated to average 2.0 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is mandatory in accordance with the 1998 Amendments to the Higher Education Act of 1965 (Pub. L. 105-244 Sec. 424) and the Higher Education Opportunity Act of 2008 (Pub. L. 110-315). Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 202010-4537 or email [email protected] and reference the OMB Control Number 1845-0113

Name of Institution: [prefilled by eCB]

State: [prefilled by eCB]

OPEID: [prefilled by eCB]

Federal Pell Grant (Pell) Program

1. Number of students with intellectual disabilities who received Pell funds _______

2. Total Pell funds disbursed to students with intellectual disabilities $ _______

Federal Supplemental Educational Opportunity Grant (FSEOG) Program

3. Number of students with intellectual disabilities who received FSEOG funds _______

4. Total FSEOG funds disbursed to students with intellectual disabilities $ _______

5. Federal share of the FSEOG funds disbursed to students with intellectual disabilities $ _______

Federal Work-Study (FWS)

6. Number of students with intellectual disabilities who earned FWS funds _______

7. Total FWS funds disbursed to students with intellectual disabilities $ _______

8. Federal share of FWS funds disbursed to students with intellectual disabilities $ _______

Unduplicated Student Count

Total unduplicated number of students with intellectual disabilities who received
Pell, FSEOG, or FWS program funds for the 2013-2014 award year _____Certification

I understand that by signing my name below that I am certifying that the information above is true and accurate and that it is subject to review by the U.S. Department of Education.

9. Chief Executive Officer (Includes President, Chancellor, and Director)

Signature: ________________________________________ Date Signed : ____________________

Title: ________________________________ Typed Name: ______________________________

Telephone No.: _________________ E-Mail Address: ____________________________

The deadline for submitting this expenditure report electronically and the signed printed copy to the U.S. Department of Education is Monday, October 1, 2014.

Electronic Submission: The deadline for electronic submission of the expenditure report is 11:59 P.M. (ET) on October 1, 2014. Transmissions must be completed and accepted by 12:00 midnight.

NOTE: You are required to submit the expenditure report electronically. You are also required to print the expenditure report to provide an original signature that must be mailed or hand delivered.

Signed Printed Copy: If the signed printed copy of the expenditure report is sent through the U.S. Postal Service, it must be postmarked by October 1, 2014 and mailed to:

United States Department of Education
Federal Student Aid
Grants & Campus-Based Division
CTP Program
830 First Street, NE
Washington, DC 20202-5453

If the signed printed copy of the report is hand delivered by a commercial courier, use the address provided above except use 20002 as the zip code and it must be delivered by 4:30 P.M. (ET) on October 1, 2014.

Due October 1, 2014

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