Application By Bureau Of Indian Education Funded Schools For Temporary Emergency Impact Aid For Displaced Students

ELEMENTARY AND SECONDARY EDUCATION 2018 APPLICATION BY BUREAU OF INDIAN EDUCATION‑FUNDED SCHOOLS FOR TEMPORARY EMERGENCY IMPACT AID FOR DISPLACED STUDENTS
BIE SCHOOL NAME : STREET/P.O. BOX : CITY : COUNTY : STATE & ZIP :
CONTACT PERSON NAME : TITLE : PHONE : FAX : E-MAIL :
Report total numbers of displaced students in the Bureau of Indian Education (BIE) school by category for each applicable quarter. Use whole numbers only. Do not include any students in more than one category in a single quarter. For each quarter, report the number of displaced students as of the reporting date for that quarter. (BIE schools must submit enrollment data for all four quarters of the 2017-18 school year, which may include estimated data for the fourth quarter. BIE schools must provide as an update to this application any updated enrollment data generally and any unreported fourth quarter data for the 2017-18 school year once that data becomes available but no later than the deadline set by the SEA.)
	Quarter 1 on __________, 2017	Quarter 2 on __________, 2017	Quarter 3 on __________, 2018	Quarter 4 on __________, 2018
BIE SCHOOLS: Total number of displaced students: enrolled in the BIE school, and who are not receiving special education and related services consistent with IDEA who are not English learners
BIE SCHOOLS: Total number of displaced students: enrolled in the BIE school, and who are receiving special education and related services consistent with IDEA
BIE SCHOOLS: Total number of displaced students: enrolled in the BIE school, who are not receiving special education and related services consistent with IDEA, and who are English learners

2018 APPLICATION BY BUREAU OF INDIAN EDUCATION‑FUNDED SCHOOLS FOR EMERGENCY IMPACT AID FOR DISPLACED STUDENTS
I certify that the statements and all of the data included in this application are, to the best of my knowledge and belief, true, complete, and correct. I certify that I am authorized to make the representations and commitments in this application, for and on behalf of the applicant, and otherwise to act as the applicant’s authorized representative in submitting this application for funding.
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:

PAGE 3 – OMB number 1810-XXXX

– Expiration date: xxxx