Form 1206 Assurance of Civil Rights Compliance

Assurance of Compliance with the National Aeronautics

and Space Administration Regulations Pursuant to

Nondiscrimination in Federally Assisted Programs

As a condition of receipt of Federal financial assistance, the Applicant Institution,

the___________________________________________________________________________ ,

(Institution, corporation, firm, or other organization on whose behalf this assurance is signed, hereafter called "Applicant.") acknowledges and agrees that it must comply (and require any subgrantees, contractors, successors, transferees, and assignees to comply) with applicable provisions of national laws and policies prohibiting discrimination, including but not limited to:

1. Title VI of the Civil Rights Act of 1964, as amended, which prohibits recipients of federal financial assistance from discriminating on the basis of race, color, or national origin (42 U.S.C. 2000d et seq.), as implemented by NASA Title VI regulations, 14 C.F.R. Part 1250.

As clarified by Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency, and resulting agency guidance, national origin discrimination includes discrimination on the basis of limited English proficiency (LEP). To ensure compliance with Title VI, the Applicant must take reasonable steps to ensure that LEP persons have meaningful access to its programs in accordance with NASA Title VI LEP Guidance to Grant Recipients (68 Fed. Reg. 70039). Meaningful access may entail providing language assistance services, including oral and written translation, where necessary. The Applicant is encouraged to consider the need for language services for LEP persons served or encountered both in developing budgets and in conducting programs and activities. Assistance and information regarding LEP obligations may be found at http://www.lep.gov.

2. Title IX of the Education Amendments of 1972, as amended, which prohibits discrimination on the basis of sex in education programs or activities (20 U.S.C. 1681 et seq.) as implemented by NASA Title IX regulations, 14 C.F.R. Part 1253. If the Applicant is an educational institution:

1. The Applicant is required to designate at least one employee to serve as its Title IX coordinator (14 C.F.R. §1253.135(a)).

2. The Applicant is required to notify all of its program beneficiaries of the name, office, address, and telephone number of the employee(s) designated to serve as the Title IX coordinators. (14 C.F.R. §1253.135(a)).

c. The Applicant is required to publish internal grievance procedures to promptly and equitably resolve complaints alleging illegal discrimination in its programs or activities (14 C.F.R. §1253.135(b).

d. The Applicant is required to take specific steps to regularly and consistently notify program beneficiaries that The Applicant do not discriminate in the operation of its programs and activities. (14 C.F.R. §1253.140).

3. Section 504 of the Rehabilitation Act of 1973, as amended, which prohibits The Applicant from discriminating on the basis of disability (29 U.S.C. 794) as implemented by NASA Section 504 regulations, 14 C.F.R. Part 1251.

1. The Applicant is required to designate at least one employee to serve as its Section 504 coordinator (14 C.F.R. §1251.106(a)).

2. The Applicant is required to notify all its program beneficiaries of the name, office, address, and telephone number of the employee(s) designated to serve as the Section 504 coordinator (14 C.F.R. §1251.106(a)).

3. The Applicant is required to publish internal grievance procedures to promptly and equitably resolve complaints alleging illegal discrimination in its programs or activities (14 C.F.R. §1251.106(b)).

4. The Applicant is required to take specific steps to regularly and consistently notify program beneficiaries that the Applicant do not discriminate in the operation of its programs and activities. (14 C.F.R. §1251.107).

4. The Age Discrimination Act of 1975, as amended, which prohibits the Applicant from discriminating on the basis of age (42 U.S.C. 6101 et seq.) as implemented by NASA Age Discrimination Act regulations, 14 C.F.R. Part 1252.

The Applicant also acknowledges and agrees that it must cooperate with any compliance review or complaint investigation conducted by NASA and comply (and require any subgrantees, contractors, successors, transferees, and assignees to comply) with applicable provisions governing NASA access to records, accounts, documents, information, facilities, and staff. The Applicant must keep such records and submit to the responsible NASA official or designee timely, complete, and accurate compliance reports at such times, and in such form and containing such information, as the responsible NASA official or his designee may determine to be necessary to ascertain whether the Applicant has complied or is complying with relevant obligations and must immediately take any measure determined necessary to effectuate this agreement. The Applicant must comply with all other reporting, data collection, and evaluation requirements, as prescribed by law or detailed in program guidance:

The Applicant must provide a response to the following at the time of submission of application:

1. If, during the past three years, you (the recipient) have been accused of discrimination on the grounds of race, color, national origin (including limited English proficiency), sex, age, disability, religion, or familial status, you must provide a list of all such proceedings, pending or completed, including outcome and copies of settlement agreements.

2. In the event any court or administrative agency makes a finding of discrimination on grounds of race, color, national origin (including limited English proficiency), sex, age, disability, religion, or familial status against you, or you settle a case or matter alleging such discrimination you must provide documentation of the finding and efforts to address it, including any voluntary compliance or other agreements between the institution and the administrative agency that made the finding.

Responses should be forwarded to:

Office of Diversity and Equal Opportunity

National Aeronautics and Space Administration

300 E St. SW

Rm. 4W33

Washington, DC 20546

OR if you prefer to respond by email to the following address:

[email address to be set up]

The United States has the right to seek judicial enforcement of these obligations.

Under penalty of perjury, the undersigned officials certify that they have read and understand their obligations as herein described, that the information submitted in conjunction with this Document is accurate and complete, and that the recipient is in compliance with the nondiscrimination requirements set out above.

Signed ________________________ _ Dated ______________________

(Applicant Responsible Official)

(President, Chairman of Board, or comparable authorized official)

Applicant's mailing address:

NASA FORM

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 10 minutes to read the instructions, gather the facts, and answer the questions.

SEND OR BRING OR EMAIL THE COMPLETED FORM TO:

Office of Diversity and Equal Opportunity

National Aeronautics and Space Administration

300 E St. SW

Rm. 4W33

Washington, DC 20546

You can find additional information on this program at http://odeo.hq.nasa.gov/external_compliance.html.

You may send comments on our time estimate above to:

Office of Diversity and Equal Opportunity

National Aeronautics and Space Administration

300 E St. SW

Rm. 4W33

Washington, DC 20546

Send only comments relating to our time estimate to this address, not the completed form.