Higher Education Hurricane and Wildfire Relief Program Application

Application for Initial Funding
under the
2018 Defraying Costs of Enrolling Displaced Students Program

CFDA Number: 84.938S

U.S. Department of Education

Washington, D.C. 20202

OMB Number: 1840-0839

Expiration Date: MM/DD/YYYY

APPLICATION INSTRUCTIONS

GENERAL INSTRUCTIONS

To receive initial funding under the 2018 Defraying Costs of Enrolling Displaced Students 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)

• Initial 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 DEFRAYING COSTS OF ENROLLING DISPLACED STUDENTS PROGRAM APPLICATION

PART 1: APPLICATION COVER SHEET

(CFDA No. 84.938S)

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 includes:

• the activities performed under the Program;

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

• a list of the displaced students, by anonymous unique identifier (such as student identification number), for whom the applicant engaged in enrollment activities funded under this program in the past year, as a result of each covered disaster or emergency, including, for each student, (1) the institution from which the student was displaced, and (2) the covered disaster or emergency that resulted in the student being displaced; and

• 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.

• 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 has incurred unexpected expenses associated with enrolling displaced students from IHEs at which operations have been disrupted by a covered disaster or emergency; and that it will notify the Secretary immediately if it no longer meets the definition of an IHE or becomes ineligible for Program funds.

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 for funding under this program.

1. In each category, identify the total amount of costs for which the applicant requests funding under this program:

(a) Tuition waived for qualifying displaced students, not including any portion covered by Federal, State, or private aid:

________________________

(b) Fees waived for qualifying displaced students, not including any portion covered by Federal, State, or private aid:

________________________

(c) Room and board costs incurred by the applicant in order to enroll qualifying displaced students, portion covered by Federal, State, or private aid:

________________________

2. Identify the total amount of other funds already received by the applicant, from any source other than the applicant itself, to help defray the unexpected costs of tuition, fees, room, and board in enrolling qualifying displaced students. To the extent that Federal, State, and private aid has already been subtracted above, do not count such amounts again here as funds already received. (The sum of all elements in (1) and (2) should not be above 100% of the total unexpected costs of tuition, fees, room, and board in enrolling qualifying displaced students.)

________________________

3. List the displaced students, by unique identifier other than social security number, for whom the applicant engaged in the enrollment activities listed in (1) and now requests funding under this program, as a result of each covered disaster or emergency, including, for each student, (a) the institution from which the student was displaced, and (b) the covered disaster or emergency that resulted in the student being displaced.

4. Describe the steps the applicant is taking to ensure accountability for the use of Program funds and compliance with legal requirements.

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.

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

• The Applicant will comply with the following regulations, as applicable: (a) The Education Department General Administrative Regulations in 34 CFR 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 CFR part 180, as adopted and amended as regulations of the Department in 2 CFR part 3485. (c) The Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards in 2 CFR part 200, as adopted and amended as regulations of the Department in 2 CFR 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 40 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 a 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.