Certification By Non Public Schools For 2018 Temporary Emergency Impact Aid For Displaced Students

ELEMENTARY AND SECONDARY EDUCATION Certification By Non‑Public Schools For 2018 TEMPORARY Emergency Impact Aid For Displaced Students
NAME OF SCHOOL : STREET/P.O. BOX : CITY : COUNTY : STATE & ZIP :
CONTACT PERSON NAME : TITLE : PHONE : FAX : E-MAIL :
Name of the local educational agency within whose boundaries this non‑public school is located:
I certify that this school is a non‑public school that meets the requirements of paragraph (b)(3) of the law governing Emergency Impact Aid . I certify that the displaced students included in the count on the attached list were enrolled in this school on the designated count date. I certify that payments to Emergency Impact Aid Accounts received from the local educational agency will be used by this school only for purposes described in sub‑paragraph (e)(2)(A) of the law governing Emergency Impact Aid. I certify that I have received and read copies of paragraph (b)(3) and sub­‑paragraph (e)(2)(A) of the law governing Emergency Impact Aid. I certify that I am authorized to make the representations and commitments in this certification, for and on behalf of this school, and otherwise to act as this school’s authorized representative in submitting this certification.
NAME AND TITLE OF AUTHORIZED REPRESENTATIVE	SIGNATURE	DATE

Appendix: Definition of Displaced Student

Displaced student

The term "displaced student'' means a student who enrolled in an elementary school or secondary school (other than the school that the student was enrolled in, or was eligible to be enrolled in, on the date that is one week prior to the date that the major disaster or emergency was declared for the area) because such student resides or resided on the date that is one week prior to the date that the major disaster or emergency was declared for the area, in an area for which a major disaster or emergency declared by the President in accordance with section 401 or 501, respectively, of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5170), related to a covered disaster or emergency.

Section 107(b)(1) of Title IV of Division B of Public Law 109-148, as modified by Division B, Subdivision 1, Title VIII of P.L. 115-123, the “Bipartisan Budget Act of 2018.”

Form Approved:

– OMB number 1810-XXXX

– Expiration date: XXXX