Higher Education Hurricane and Wildfire Relief Program Application

OMB No.: 1840-0839

Form Expires: MM/DD/YYYY

Emergency Assistance to Institutions of Higher Education Program (2018)

PRE-APPLICATION INFORMATION

IHE seeking an award: __________________________________________________________

Location: State: ___________________ County: ___________________________________

Legal Address: _________________________________________________________________

______________________________________________________________________________

Contact person: Name ___________________________________________________

Title ____________________________________________________

Telephone ________________________________________________

E-mail ___________________________________________________

Briefly describe the extent of the impact on your institution of the covered disasters or emergencies (defined in the notice inviting applications for this program). To what extent was the institution forced to close or relocate, or to what extent were operations impaired as a result of damage directly caused by the covered disasters or emergencies? Please feel free to include additional pages. We recommend limiting additional material to ten pages.

Please include (a) whether the institution was forced to close or relocate, and if so, (b) for how many days. If more than one covered disaster or emergency applies to your institution, please aggregate your narrative across all of those events.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

The amount of each award under this program will be determined by a formula including the elements noted below. This formula will be used to allocate an equitable proportion of available funds to each eligible institution. This pre-application does not constitute a “claim” for a certain amount of funds by the institution or a commitment to provide funds by the Department.

Note: Each applicant must retain the original documents supporting the information supplied in this pre-application for the purpose of any future audits. Do not send those documents as part of your application for an award.

Please record the following amounts, rounding dollar amounts to the nearest $1,000. If more than one covered disaster or emergency affected your institution, please aggregate the amounts for all of those events.

1. Expenses already incurred by the institution in remediation of the effects of the covered disasters or emergencies:

$_____________________

Note: For the purposes of these awards, “expenses already incurred” is defined as expenses paid or accrued as a direct consequence of the covered disasters or emergencies. These may include, for example, costs of evacuation, temporary lodging, cleanup, alternative facilities and operations, equipment repair and replacement, or unusual personnel costs.

2. Estimated construction or reconstruction costs to repair or replace buildings damaged or destroyed due to the covered disasters or emergencies:

$_____________________

Note: For the purposes of these awards, “estimated construction costs” is defined as costs incurred, or reasonably expected to be incurred, to repair or replace facilities damaged by the covered disasters or emergencies, as calculated for a third party such as the Federal Emergency Management Administration, the state, or insurance claims. Do not include any expenses included in #1 above.

3. Further need for project. (a) Additional expected expenses, for any purpose authorized under the Higher Education Act, that are not included in #1 or #2 in remediation of the effects of the covered disasters or emergencies:

$_____________________

(b) the estimated percentage of operations, as a proportion of your institution’s operations prior to the occurrence of the covered disaster or emergency, that remain impaired as a result of the covered disaster or emergency. This percentage should be estimated on the basis of year-over-year spending or budget, using spring 2017 as the baseline. For example, if your institution’s spring 2017 spending was $100 million and your institution’s spring 2018 budget is $75 million, you should report that your institution is operating at 75%.

_____________ percent

4. (a) Portion of expenses in lines 1–3 above (in dollars, not percent) directly serving students who are homeless or at risk of becoming homeless as a result of displacement due to the covered disasters or emergencies. Such expenses may include work to identify such students, outreach to such students, food, employment, housing, counseling, emergency grants, transportation, and other services, so long as all such expenses are authorized under the Higher Education Act. Include only those expenses directed to students who are homeless or at risk of becoming homeless. Do not include expenses directed to a larger population of students, even if those expenses have aided some students who were homeless or at risk of becoming homeless. Do, however, include expenses directed toward individual students who are homeless or at risk of becoming homeless even if similar aid or services have been made available to other students.

$_____________________

(b) Number of students who are homeless or at risk of becoming homeless: _________

(c) Total student enrollment immediately prior to the first applicable covered disaster or emergency:

________________

(d) Total student enrollment at time of application (including students counted in part (b)):

________________

5. Please estimate how much of the expenses described in lines 1-3 above (dollars, not percent) will be or has been reimbursed by insurance (property, business continuity, or other applicable insurance policy or self-insurance arrangement), other Federal agencies, and all public and private donors of any kind other than the institution itself.

$_____________________

Note: For the purposes of item 5, (a) do not include donations of less than $1,000; (b) an institution’s endowment, even if held by an organization separate from the institution, is considered to belong to the institution itself; and (c) funds from an institution’s own charitable foundation (“University of X Foundation”) are considered to have come from the institution itself, even if that foundation is an independent nonprofit organization. Please note that “supplement-not-supplant” requirements prohibit a grantee from supplanting other funds.

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 10 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.