Higher Education Hurricane and Wildfire Relief Program Application

Application for Initial Funding
under the
2018 Emergency Assistance to Institutions of Higher Education Program

CFDA Number: 84.938T

U.S. Department of Education

Washington, D.C. 20202

OMB Number: 1840-NEW

Expiration Date: MM/DD/YYYY

APPLICATION INSTRUCTIONS

GENERAL INSTRUCTIONS

To receive funds under the 2018 Emergency Assistance to Institutions of Higher Education Program (Program), an eligible Institution of Higher Education (IHE) must submit to the Department an application that provides the following information:

• A completed application cover sheet. (Part 1 of the Application)

• Fiscal, transparency, and reporting assurances. (Part 2 of the Application)

• Plan for the use of funds under the Program. (Part 3 of the Application)

• Other assurances and certifications. (Part 4 of the Application)

SUBMISSION INFORMATION

Please submit your application to the Department as follows:

1. Email an electronic version of your application in PDF (Portable Document Format) to [email protected] or

2. Mail the original and two copies of your application by express mail service through the U.S. Postal Service or through a commercial carrier to the following address:

Linda Byrd-Johnson

Office of Postsecondary Education

U.S. Department of Education

400 Maryland Avenue, S.W., room 270-02

Washington, D.C. 20202-6200

2018 EMERGENCY ASSISTANCE TO INSTITUTIONS OF HIGHER EDUCATION PROGRAM APPLICATION

PART 1: APPLICATION COVER SHEET

(CFDA No. 84.938T)

[Legal Name of Applicant (Office of the President/Chancellor)]:	Applicant’s Mailing Address:
Applicant’s Contact for the Program Name: Position and Office: Mailing Address: Telephone: Fax (optional): Email:
To the best of my knowledge and belief, all of the information and data in this application are true and correct.
President/Chancellor or Authorized Representative (Printed Name):		Telephone:
Signature of President/Chancellor or Authorized Representative		Date:

Part 2: FISCAL, transparency, and

reporting assurances

1. The Applicant assures the Secretary that it will comply with all of the fiscal, transparency, and reporting requirements that apply to the Program, including the following:

• For each year of the Program, the Applicant will submit a report to the Secretary, at such time and in such manner as the Secretary may require, that describes:

• how the Applicant distributed the funds it received, including the amount of funds used for each authorized activity;

• the activities performed under the Program;

• the number of enrolled students;

• the number of enrolled students who received financial assistance from Program funds;

• a description of the internal controls the Applicant had in place to ensure that funds were used for allowable purposes and in accordance with cash management principles; and

• the estimated percentage of the Applicant’s operations, as a proportion of the Applicant’s operations prior to the occurrence of the covered disaster or emergency, that remain impaired due to the covered disaster or emergency. This percentage should be estimated on the basis of year-over-year spending or budget for the spring term of each year, using spring 2017 as the baseline. For example, if an institution’s spring 2017 spending was $100 million and its spring 2018 budget is $75 million, the institution should report that it is operating at 75 percent.

• The Applicant will cooperate with any evaluation of the uses of funds including any Inspector General examination of records under the program.

2. The Applicant assures the Secretary that it is an eligible Institution of Higher Education (IHE) as defined in Section 101 or Section 102(a) of the Higher Education Act of 1965, as amended; that it is located in an area affected by a covered disaster or emergency; and that it will notify the Department immediately if it no longer meets the definition of an IHE, relocates its operations, or permanently leaves the affected area.

President/Chancellor or Authorized Representative (Printed Name):
Signature:	Date:

Part 3: initial plan for the use of funds under THE program

NOTE: Additional information and validation of data may be required.

1. A description of the Applicant’s strategies for becoming fully operational, prioritizing, to the extent possible, students who are homeless or at risk of becoming homeless as a result of displacement due to the covered disaster or emergency.

2. A description of the activities that the Applicant plans to support with Program funds, including the cost of each activity and the third-party funds already allocated to that activity.

3. The Applicant’s proposed timeline for executing its strategy and activities under the grant.

4. A description of the steps the Applicant is taking to ensure accountability for the use of Program funds and compliance with legislative requirements.

5. The total amount of aid requested.

President/Chancellor or Authorized Representative (Printed Name):
Signature:	Date:

Part 4: OTHER Assurances and certifications

The Applicant or Applicant’s authorized representative assures or certifies the following:

• The Applicant will comply with all applicable assurances in OMB Standard Forms 424B and D (Assurances for Non-Construction and Construction Programs), including the assurances relating to the legal authority to apply for assistance; access to records; conflict of interest; merit systems; nondiscrimination; Hatch Act provisions; labor standards; flood hazards; historic preservation; protection of human subjects; animal welfare; lead-based paint; Single Audit Act; and the general agreement to comply with all applicable Federal laws, executive orders, regulations, and policies governing this program.

• With respect to the certification regarding lobbying in Department Form 80-0013, no Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the making or renewal of Federal grants under this program; the Applicant will complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," when required (34 C.F.R. Part 82, Appendix B); and the Applicant will require the full certification, as set forth in 34 C.F.R. Part 82, Appendix A, in the award documents for all subawards at all tiers.

• The Applicant will comply with the requirements of section 427 of GEPA (20 U.S.C. 1228a). The Applicant must describe the steps it proposes to take to ensure equitable access to, and equitable participation in, the activities to be conducted under the Program, by addressing the special needs of students, teachers, and other program beneficiaries in order to overcome barriers to equitable participation, including barriers based on gender, race, color, national origin, disability, and age.

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• The Applicant will comply with the following regulations, as applicable: (a) The Education Department General Administrative Regulations in 34 C.F.R. parts 75, 77, 79, 81, 82, 84, 97, 98, and 99. (b) The Office of Management and Budget Guidelines to Agencies on Governmentwide Debarment and Suspension (Nonprocurement) in 2 C.F.R. part 180, as adopted and amended as regulations of the Department in 2 C.F.R. part 3485. (c) The Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards in 2 C.F.R. part 200, as adopted and amended as regulations of the Department in 2 C.F.R. part 3474.

President/Chancellor or Authorized Representative (Printed Name):
Signature:	Date:

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 30 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 required to obtain or retain benefit (Bipartisan Budget Act of 2018). Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to regulations.gov during the public comment period for this collection of information.  If you have specific questions about the form, instrument or survey, please contact Higher Education Programs, Office of Postsecondary Education, U.S. Department of Education, 400 Maryland Avenue SW, Washington DC 20202.