EASIE Part II

U.S. DEPARTMENT OF EDUCATION
OFFICE OF ELEMENTARY AND SECONDARY EDUCATION
WASHINGTON, DC 20202-6335

INDIAN EDUCATION PROGRAMS
Application for Formula Grants to
Local Educational Agencies (LEAs)
CFDA Number: 84.060A

Formula Grant EASIE
(Electronic Application System for Indian Education)

Part II

Disclaimer
This is a hard-copy representation of the EASIE online system which is located U.S. Department of Education’s EDFacts portal.
Applicants must apply on EASIE unless they qualify for and receive a paper application. Directions are located in the Notice Inviting
Application found in the Federal Register.

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. The valid OMB control number for Formula Grant EASIE (Electronic Application System for Indian
Education) is 1810-0021. The time required to complete the information collection is estimated to average 9 hours 16 minutes per response,
inclusive of both Part I and Part II, including the time to review instructions, search existing data resources, gather the data needed, and
complete and review the information collection. If you have any comments concerning the accuracy of the time estimate or suggestions for
improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4700. If you have comments or concerns
regarding the status of your individual submission of this form, write directly to: Office of Indian Education, U.S. Department of Education,
Lyndon B. Johnson Building, 400 Maryland Avenue, S.W., Room 3W227, Washington, DC 20202-6335.

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U.S. Department of Education
Office of Indian Education
Program Overview
This package contains instructions and forms for Part II of grant applications for the Formula
Grants to Local Educational Agencies Program (CFDA 84.060). The purpose of the Indian
Education Formula Grant program, as authorized under Section 6116 of the Elementary and
Secondary Education Act of 1965 (ESEA), as amended by the Every Student Succeeds Act
(ESSA), is to support local educational agencies in their efforts to reform elementary and
secondary school programs that serve Indian students. The programs funded are to meet the
unique cultural, language, and educational needs of Indian students and ensure that all students
meet the challenging State academic standards. The instructions in this hard-copy representation
of the application package can be used in developing your application.
Applying for Funds
Applicants for grants from the U.S. Department of Education (ED) must apply for limited funds.
Deadlines assure that all applicants are treated fairly, equally, and without last minute haste. The
rules, including the deadline, for applying for each grant are published, individually, in the
Federal Register.
Formula Grant EASIE
The method for applying for funds for this program is online using the Formula Grant Electronic
Application System for Indian Education (Formula Grant EASIE). EASIE online system which
is located U.S. Department of Education’s EDFacts portal.
Office of Indian Education
The following is the contact information for the Office of Indian Education (OIE).
Website:
http://www2.ed.gov/programs/indianformula/contacts.html.
Telephone:
202-260-3774
Fax:
202-205-0606
Email:
[email protected]
Partner Support Center
Contact the Partner Support Center for technical assistance to register or update your access to
Formula Grant EASIE.
Website:
https://easie.grads360.org
Telephone:
877-457-3336 (877-HLP-EDEN)
Fax:
888-329-3336 (888-FAX-EDEN)
Federal Relay Service:800-877-0996 (Voice/TTY) / [email protected]
Email:
[email protected]
Application Due Date
Applications must be submitted on or before XXX XX, 20XX. Please note that the Department
of Education (Department) grant application deadlines are 8:00:00 P.M. Washington, D.C. time.
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Community of Practice Website
This website was created to provide year-round, end-user support for all parts of the Indian
Education Formula Grant EASIE. It includes pages for Parts I, II, and III (APR) with forms and
supporting documentation, webinars and instructional videos. https://easie.grads360.org
Application Deadlines
Applications submitted must address all required information in order to be funded.
• Part I of the application consists of the application type, Indian student count and application
cycle. If Part I is submitted by the closing date, you will complete an application for Part II.
•

Part II of the application contains six sections:
Section 1. General Applicant Information
Section 2. Coordination of Services for American Indian/Alaska Native Students
Section 3. Indian Education Project Description
Section 4. Budget Information
Section 5. Section 427 of the General Education Provisions Act (GEPA)
Section 6: Comments

When applicable, the applicant also must submit:
•
•
•
•
•

Signed consortium agreement during EASIE Part I;
Signed evidence of eligibility form during EASIE Part I;
Indian Parent Committee Approval form;
Copy of the indirect cost rate agreement;
Administrative Cost Limit Waiver Request.

Late applications will not be accepted.
We strongly suggest that you submit your application several days before the deadline. The
Department is required to enforce the established deadline to ensure fairness to all applicants.
No changes or additions to an application will be accepted after the deadline date and time.
Applicants must meet the deadlines for both EASIE Part I and Part II to receive a grant. Any
application not meeting the Part I and Part II deadlines will not be considered for funding.
Current Contact Information
As part of our review of your application, we may need to contact you with questions for
clarification. Please be sure your application contains at least three valid e-mail addresses
(general user, managing user and certifying official users) for the project director and authorized
representative or another party designated to answer questions in the event the project director
and authorized representative are unavailable.
ISDEAA Hiring Preference Requirements
Grants that serve primarily members of Federally-recognized Tribes are subject to the provisions
of section 7(b) of the Indian Self-Determination and Education Assistance Act (Pub. L. 93-638).
That section requires that, to the greatest extent feasible, a grantee give to Indians preferences
and opportunities for training and employment in connection with the administration of the
grant; and give to Indian organizations and to Indian-owned economic enterprises, as defined in
section 3 of the Indian Financing Act of 1974 (25 U.S.C. 1452e)).

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Specific Instructions for Formula Grant EASIE Part II
Required Items. This sample application package has six sections; each section consists of one
or more questions or one or more tables. The items that you must complete and submit is
determined by several factors.
Type of application
• regular formula grant program
• formula grant project consolidated with a Title I schoolwide program
• integration of services under ESEA section 6116
Single entity applicant or multi-entity applicant
• If you are a single-entity applicant (a single LEA, or a single BIE school, or a Tribe,
Indian organization or Indian community-based organization applying in lieu of a single
LEA), then you must complete each of the required items once for your project.
• If you are a multi-entity applicant (a consortium of LEAs, a consortium of BIE schools,
or a Tribe, Indian organization, Indian community-based organization applying in lieu of
multiple LEAs) then you must complete each of the required items for your project.
Indian Parent Committee Information Requirement
• If you are an LEA or an LEA consortium, you must upload the Indian Parent Committee
Application Approval, Indian Parent Committee Membership List and Indian Parent
Committee Bylaws into the EDFacts Submission System (ESS) before EASIE Part II
closes.
• If you are a Bureau school, Tribe, Indian organization or Indian Community Based
Organization applying in lieu of an LEA(s), then you do not need to upload the Indian
Parent Committee Information.
• The Indian Parent Committee Information must be uploaded on or before the EASIE Part
II deadline to be considered eligible for funding.
Section 427 of the General Education Provisions Act (GEPA)
Section 427 requires each applicant for funds (other than an individual person) to include in its
application a description of the steps the applicant proposes to take to ensure equitable access to,
and participation in, its Federally-assisted program for students, teachers, and other program
beneficiaries with special needs.
Comments to the Office of Indian Education
• Provide brief explanatory information about application.
Complete all required items and include all required forms in your submission package. If you
are an LEA, provide a copy to your state education agency and to keep a file copy.
Item-by-Item Instructions. Instructions for each item are contained in the form. This
application contains a very limited amount of free narrative response. Where you are asked to
select items from a list to enter into a table, please use only those items. Other responses will not
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be accepted. Consult the FAQ document for additional explanatory information. To access the
FAQ document, go to the main page of EASIE and click on Getting Started or the Community of
Practice website.

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OMB Number 1810-0021
Expiration Date:

Formula Grants EASIE Part II
Project Description and Budget Detail
Section 1: General Project Information
1. Project Information.
Fill in the following information:
Applicant Name:___________________________
DUNS #: XXXXXXXXX
PR # S060AXXXXXX
Allocation: $XX,XXX
Allocation was based on student count of: X,XXX
2. Application Type.
Identify the type of application you are submitting (check only one):
___ Regular formula grant program (complete items sections 1-4; complete section 5 if applying
for a waiver; and complete section 6 and 7.).
___ Formula grant project funds consolidated with a Title I schoolwide program (complete
sections 1-3; and complete section 6 and 7).
___ Integration of services under ESSA section 6116 (complete items in sections 1; complete
section 5 if applying for a waiver; and complete section 6 and 7).)
Award start date. July 1, 20XX to June 30, 20XX
3. Grades Offered in SY 20XX-XX.
Indicate the grade levels offered by this LEA. Check all that apply. Grades offered refers to the
grades at which instruction is offered to students by the LEA or BIE school district. This is
unrelated to whether any Indian students are in that grade or whether your Title VI project will
provide activities/services for that grade.
__PK __K __1 __2 __3 __4 __5 __6 __7 __8 __9 __10 __11 __12
4. List the Project Director and Authorized Representative Information.
Project Director of the Grantee:
Name: ______________________________________________________
Tel: _________________________
Fax: ____________________
E-mail: ______________________________________________________

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Authorized Representative of the Grantee:
Name:_______________________________________________________
Tel: ________________________
Fax: ____________________
E-mail: ______________________________________________________
Section 2: Comprehensive Program for American Indian/Alaska Native Students
1. Coordination of Services with Formula Grant Programs.
Please indicate which of the following LEA programs: [a] were available in your district during
the last school year (20XX-XX); and [b] if that program is currently coordinated with Title VI
services.

Programs

[a] Is this
program
available?
YES

NO

[b] Is this
program
coordinated
with Title VI
services?
YES

NO

Department of Education Formula Grant Programs (please specify):
Title I
Homeless Children and Youth
Title III: English Language Acquisition
School Improvement Grants
Rural and Low-Income School Program
Impact Aid
Migrant Education
Other:
Other:
Other Federal, tribal, State, or local Programs (please specify):
BIE: Johnson O'Malley
Other:

2. Description of Comprehensive Program for American Indian/Alaska Native Students
Each application must include a description of the applicant’s comprehensive program for
meeting the culturally related academic needs of Indian children, including their language and
cultural needs.
Describe how the comprehensive program for AI/AN Students (using a variety of funding
sources) will meet the culturally-related academic needs of AI/AN students, including their
language and cultural needs with an explanation of specific programs and activities. In
addition to your explanation of the comprehensive program, also include programs and
activities from the chart above (Coordination of Services with Formula Grant Programs) that
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currently coordinate with your Title VI project, or which will coordinate with Title VI
during the grant year.
Enter narrative response here (Please limit to 2,000 characters):

3. Coordination of Services Professional Development.
Describe the professional development opportunities that will be provided by your coordination
of services to ensure that teachers and other school professionals who are new to the Indian
community are prepared to work with Indian children, and all teachers who will be involved in
programs assisted by this grant, have been properly trained to carry out such programs. The
professional development opportunity or opportunities can be funded using other local, State,
and/or federal funds.
Note: The professional development opportunity or opportunities identified do not have to be
new opportunities or opportunities for which funding is requested. Applicants should include
existing professional development opportunities that will continue to be implemented in the
school year for which funding is requested, as long as those opportunities are components of
the coordinated services program.
Permissible Values
Instructions for completing the table:
(1) Using permissible values, enter the types of staff that will be served by professional
development activities to support the coordination of services program in column (a).
Use a new row for each type of staff.
(2) Using permissible values, in column (b) enter the type of professional development
activity that each type of staff identified in column a will receive.
(3) Using permissible values, in column (c) enter the content of each professional
development activity entered in column (b).
Permissible Values
Coordination of Services Program Professional Development Activities for SY 20XX-XX

Column a
Types of staff

Column b
Type of professional development activity

Column c
Content

Column a: pick one or more of the following:
• All teachers and other school professionals
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•
•
•
•

Teachers and other school professionals that are new to the Indian community
Subset of teachers
LEA staff (example, Title VI coordinators)
Other non-teaching staff (examples: counselors, Parent Committee)

Column b: pick one or more of the following:
• Workshops/Sessions
• Conferences, including national, regional, state, or LEA-sponsored
• Pre-service training or orientation
• School-based coaching or mentoring
• Other (example: online courses, webinars, Tribal Agency training) --if you select
“Other” as a professional development activity, enter “Other” in column b of a row and
also specify the activity there.
Column c: pick one or more of the following:
• Indian Education-specific (example: instruction specific to language or specific
Indian curricula)
• Cultural Awareness Education and Sensitivity (example: working with Indian students)
• Use of Data/ Data-driven decision making (example: examining patterns in Indian
Student test data; using data to focus instruction for AI students; identification of
exceptional students)
• Impact of district policies on AI students (example: grading policies, attendance policies,
discipline, suspensions, etc.)
• Other--if you select “Other” as content, enter “Other” in column c of a row and
also specify the content there.
4. Dissemination of Assessment Data.
Provide information on how the state assessment data of all Indian students (not just those
served) are used. Indicate how you plan to disseminate information to the Indian Community,
Parent Committee and the Indian Tribes whose children are served by the local education
agency. Check all that apply. All applicants must respond to these items.
Method of dissemination to Indian Community and Parent Committee:
___ Public hearing for application
___ Indian Parent Committee meeting
___ Other open meeting
___ Within a written report
___ Posted on website
___ Sent home with student(s)
___ Radio broadcast
___ Newsletter
5. Additional Assessment Data Use.
Indicate how assessment data from the previous school year were used (check all that apply)
___ No changes in services/programs
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___ Modification to services/programs at LEA level
Describe: __________________________
___ Modification to services/programs within project
Describe: ___________________________
6. Public Hearing Requirement Data.
Having a public hearing satisfies the program requirement of providing a full opportunity to
understand the program and to offer recommendations regarding the program. Holding a public
hearing is a required element for all Indian Education Formula Grant applicants and must be
conducted prior to application certification. Indicate the date on when the public hearing was
held for SY 20XX-XX. It was held on this date: _____________
7. Description of Meaningful Collaboration with Tribes.
To be answered by LEAs, LEA-C, BIE Operated, and Bureau Grant and Contract Schools and
Consortium of BIE contract/grant schools only.
As required by ESEA Section 6114, provide information detailing your LEA’s meaningful
collaboration with Tribes located in the community in the development of the comprehensive
program and the results of the collaboration.
1. Are there local Indian Tribes located in the community? Yes/No
2. List the local Indian Tribe(s)___________________________
In the section below, describe the process the LEA used to meaningfully collaborate with Indian
Tribes located in the community in a timely, active, and ongoing manner in the development of
the comprehensive program and the actions taken as a result of such collaboration.
Enter narrative response here (please limit to 2,000 characters).

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Section 3: Indian Education Project Description

If you are applying as a regular formula grant program, then you must complete this
section; however, applicants submitting as a project consolidated with a Title I schoolwide
program will answer question 2. Applicants submitting under section 6116 (Integrated
Services) should skip the following section.
1. Indian Education Formula Grant Objectives.
Identify your specific project objectives towards the goal of providing culturallyresponsive education for AI/AN students to meet their academic needs and help them meet
State achievement standards. The objectives listed in the table align to the allowable
activities and services as specified in Section 6115(b) of the ESEA.
Select grade level(s) served by activity or service
 Pre-K
 Elementary school grades
 Middle school grades
 High school grades
Permissible Values
Instructions for completing the table:
Complete a separate table for each objective. You must have at least one objective;
however, you may have several.
(1) Select grade level to be served by activity or service.
(2) Select a permissible value for each objective.
(3) In column (a), identify each activity or service that will be used to address the
objective. Use a separate row for each activity or service.
(4) In column (b), identify the data source for each activity or service.
Grade level to be served by activity or service: ____________________
Proposed Project Objectives
Objective #1:
Column a
Type(s) of activity or
service

Column b
Data Source (s)

Objective: The goal of providing culturally-responsive education for AI/AN students to
meet their academic needs and help them meet State achievement standards.
• Increase school readiness
• Increase academic achievement
• Increase knowledge of cultural identity and awareness
• Enhance problem solving and cognitive skills development and directly support
attainment of State standards
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•
•
•
•
•
•
•
•
•

Increase school attendance rate
Decrease school dropout rate
Increase graduation rate
Increase career readiness skills (e.g., technology skills, leadership skills)
Increase college enrollment
Increase prevention activities for violence, suicide, and substance abuse
Increase parent participation
Increase Native American Language instruction programs
Increase support for at-risk students

Column a: Type(s) of supplemental activity or service that support the objective
• Native Language Instruction
• Culturally-responsive early childhood programs and activities
• Culturally-responsive professional development
• Indian education, including language and history)
• Cultural enrichment (e.g., events, field trips, clubs)
• Culturally-responsive academic support (e.g., study skills, homework support)
o Overall, in reading or ELA, in mathematics, in science, in other subjects (e.g.,
social studies)
• Culturally-responsive academic enrichment (e.g., after school programs, projects)
• College preparation (e.g., ACT or SAT preparation, exploration, advanced placement
classes or testing)
• Career preparation (e.g., technology skills, internships)
• Gifted and talented programs
• Student advocacy or leadership
• Culturally-responsive mentoring
• Substance abuse prevention
• Suicide prevention
• Violence prevention
• Culturally-responsive counseling
• Family literacy with culturally-based materials
• Parent involvement
• Drop-out prevention strategies
• Programs for students in correctional facilities
• Summer school
Column b: Data source that support the objective
• School readiness screening
• Documents (e.g., lesson plans, curriculum)
• State standardized test
• District benchmark assessment
• Other standardized achievement test
• Non-standardized achievement test
• Student portfolios
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•
•
•
•
•
•
•
•
•
•

Teacher surveys, interviews, or focus groups
Classroom observations
Parent surveys, interviews, or focus groups
Student surveys, interviews, or focus groups
Administrator surveys, interviews, or focus groups
Attendance data
Dropout data
Graduation data
College application and acceptance data
Other data source –

Note: If you select “Other data source” enter “Other data source” in column b of a row and also
specify the data source
2. School-wide applicant’s objectives and use of funds (only)
As required by ESEA Section 6115(c), Title I schoolwide applicants must identify how the use
of funds in a school-wide program will produce benefits to Indian students that would not be
achieved if the funds were not used in a schoolwide program.
In the section below, describe how the use of funds in a Title I schoolwide program will produce
benefits to Indian students that would not be achieved if the funds were not used in a schoolwide
program.
Enter narrative response here (please limit to 2000 characters).

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Section 4: Budget Information

Complete the budget section for your project (not separately for each participating LEA). The
budget must match the objectives you selected for items in section 3. The information you enter
covers the entire project including all participating LEAs.
Total costs in your budget cannot exceed your allocation. If your administrative costs exceed 5%
of your allocation, you must reduce those costs to less than 5%, or complete the waiver request
form (section 5).
Note: Applicants submitting as a Title VI project consolidated with a Title I schoolwide
program should skip Section 4. Applicants submitting under section 6116 (Integrated Services)
must complete the Information for Information for Application Under 6116.
1. Supplemental Information.
By checking this box, I will ensure that the Indian Education formula grant funds will supplement
and not supplant other funding for the education of Indian children, with the goal of providing
culturally-responsive education to meet the academic needs of AI/AN students and to assist those
students in meeting State achievement standards. See FAQs for guidance and examples.
2. Personnel Budget.
Complete the table for personnel to be funded by the project. Permissible values. Complete rows
a-g (Project Director and Project Coordinator) as they are applicable. Complete additional rows
for each type of personnel at each certification status and each percentage of time.
Column a: Types of Personnel
Academic Advisors
Administrative Assistants
College instructors
Counselors, Guidance
Counselors, Mental Health
Cultural Resource Specialists
Data Specialists
Home/School Coordinators
Instructional Assistants
Language Instructors
Liaisons, Home/School or Community
Reading Coaches or Specialists
Social workers
Support, Clerical or Secretarial
Teachers
Tribal Elders
Youth Development Specialists

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Other (If you select “Other”, enter “Other” in column a of a row and also specify the personnel
type it represents.
For each row, enter in column (b) the number of personnel in this group; enter in column (c) the
percent of time that group of personnel will be assigned to and funded by the project; enter dollar
values in columns (d), (e) and (f); enter in column (g) the sum of the values for columns (d), (e),
and (f) for that row. Use as many rows as necessary.
[Example, if you have some academic advisors who work 20% time on the project and other
academic advisors who work 30% time on the project, you would need to complete two rows for
academic advisors.]
On the last row of your table, enter the column totals for columns d, e, f, and g.

a
Type of Personnel

b
#

Your Project’s Personnel Budget
c
d
e
f
% of Admin Program Fringe Cost ($)
time Cost ($) Cost ($)

g
Total Cost ($)

Project Director
Project Coordinator

Category Subtotals

3. Travel Budget.
Complete the table for travel to be funded by the project. Enter the dollar value for each type of
travel. Enter row and column totals.
LIMITATION ON THE USE OF FUNDS. Funds provided to a grantee under this subpart may
not be used for long-distance travel expenses for training activities that are available locally or
regionally.

Type of Travel
In-district (non-PD)
Out of district (non-PD)
Professional development
(only)
Category Subtotals

Your Project’s Travel Budget
Admin Cost ($)
Program Cost ($)

Total Cost ($)

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4. Equipment Budget.
Complete the table for equipment to be funded by the program (defined as a single item with
value exceeding $5,000).
In column (a), identify the item in your own words.
In column (b), enter the code to identify the purpose as one of the following:
Instr = Instructional Service Delivery
Prog Mgmt = Program Management
In columns (c) and (d), enter dollar values. Use as many rows as necessary. Enter row and
column totals.

a
Item

Your Project’s Equipment Budget
b
c
d
Purpose
Admin Cost Program Cost
($)
($)

e
Total Cost
($)

Category Subtotals
5. Supplies Budget.
Complete the table for supplies to be funded by the project. Enter the dollar value for supplies of
each listed type. Note that Direct Instructional Materials and Student Consumables have no
administrative cost. Enter row and column totals.

a
Item
Direct Instructional
Delivery
Student Consumables
Technology
Program Management
Category Subtotals

Your Project’s Supplies Budget
b
c
Admin Cost ($)
Program Cost ($)

d
Total Cost ($)

6. Contractual Budget.
Complete the table for contractual services to be funded by the project. Enter the dollar value for
contractual services for each listed purpose. Note that Direct Instructional Delivery and Student
Evaluations have no administrative cost. If you use the row for “Other”, describe the expense in
the column (a). Enter row and column totals.

a
Purpose
Direct Instructional
Delivery
Student Evaluations

Your Project’s Contractual Budget
b
c
Admin Cost ($)
Program Cost ($)

d
Total Cost ($)

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Other. Specify:
Category subtotals

7. Other Budget.
Complete the table for other expenses to be funded by the project. Enter the dollar value for other
expenses for each listed purpose. Note: Direct Instructional Materials, Student Activities Related
to Services, and Student Consumables have no administrative cost. If you use the row for
“Other”, describe the expense in the column (a). Enter row and column totals.

a
Purpose
Direct Instructional
Delivery
Student Activities Related to
Services
Professional Development
(non-travel related)
Other. Specify:

Your Project’s Other Budget
b
c
Admin Cost ($)
Program Cost ($)

d
Total Cost ($)

Category subtotals
8. Indirect Costs.
Enter your entity’s restricted indirect cost rate. The rate should be entered as a percent and may
have up to two decimal places (e.g. 4.08%). If you choose to budget project funds for indirect
costs, enter the total amount of indirect costs associated with the project. You are entitled to
budget indirect costs from your Title VI allocation up to a maximum of your indirect cost rate
times your allocation.
You can budget a lesser amount of your indirect costs from your Title VI allocation. You do not
have to budget for indirect costs. In that case, you may leave the table blank.
Your Project’s Indirect Costs
Rate (%)

Total ($)

Section 5: Section 427 of General Education Provisions Act (GEPA)
Section 427 of the General Education Provisions Act (GEPA)
As required by section 427 of the GEPA, all applicants must describe the steps the applicant
proposes to take to ensure equitable access to, and participation in, its federally-assisted program
for students, teachers, and other program beneficiaries with special needs.
Enter narrative response here (please limit to 2000 characters).
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Section 6: Comments
Comment.
Use the space below (limited to 2000 characters) to provide additional information including the
following: (a) If you selected “other” from any drop-down menu, provide comments describing
the reason why “other” was selected; if there is not define it here is there is not space to define it
within the data sections. (b) If needed, provide an explanation of any anomalies that assist the
Department in analyzing your application.
Enter narrative response here (please limit to 2000 characters).

Certification

Certification.
An authorized official must certify as follows.
 I, the legal authorized representative, have read and downloaded the program assurance
forms, Standard Form 424B Assurances – Non-Construction Programs and Additional
Program and Assurances for 84.060-Indian Education Formula Grants, and agree to their
provisions. NOTE: You do not need to sign and upload the program assurances;
however, checking the checkbox is equivalent to a signature. You should keep a signed
copy on file for your project records.
 I certify that, if required, all the Indian Student Eligibility Certification Forms for Title VI
Indian Education Formula Grant Program (ED 506 Forms) are on file and will be
provided to the OIE upon request.
 I certify that the project for which application is made in open consultation with parents
and family members of Indian children, representatives of Indian tribes on Indian lands
located within 50 miles of any school that the agency will serve if such tribes have any
children in such schools, teachers and, if appropriate, Indian students from secondary
schools, including through public hearings held to provide a full opportunity to
understand the program and to offer recommendations regarding the program.
 I certify that, if required, the Indian Parent Committee (IPC) participated in the
development of the application submitted and approves the proposed application. I have
uploaded the IPC Information which includes IPC approval of the EASIE application and
the IPC membership to verify composition. I have also uploaded the IPC Bylaws.
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 I certify that I am an employee authorized to legally bind this entity, and that by
accepting the award for the Indian Education Formula Grant Program, this grantee will
comply with all program assurances, agrees to carry out the program and meet all
applicable requirements described herein. I certify that, to the best of my knowledge, the
information in this application is true, reliable, and valid and I understand that any false
statement provided herein that I have made is subject to penalties under The False Claims
Act, 18 U.S.C. 1001.
Authorized signature: _____________________
Printed name

__________________________

_____________________________
Title
______________________________
Date

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Additional Documents

Program Summary for Applications Under Section 6116, Integrated Services.
This table is must be completed by projects that submit a plan for the integration of education
and related services provided to Indian students under Section 6116 of Every Student Succeeds
Act, as amended. Funds from any Federal program exclusively serving Indian children, or the
funds reserved under any Federal program to exclusively serve Indian children, received through
a statutory or administrative formula for the purposes of providing education and related services
to serve Indian students, may be consolidated in a demonstration project that integrates the
program services involved into a single, coordinated, comprehensive program and reduces
administrative costs by consolidating administrative functions.
Applicants submitting under this provision must complete the following table in lieu of table 9.
List the services to be provided, the entity providing the service, and the timeframe for service
delivery.
Your Project Summary for a SY 20XX-XX Application Under Section 6116
a
b
c
Service(s) to be Provided
Entity Providing Service
Timeframe for Service
Delivery

Budget Summary for Applications Under Section 6116, Integrated Services.
This budget table must be completed by projects that submit a plan for the integration of
education and related services provided to Indian students under Section 6116 of the Elementary
and Secondary Education Act, as amended. Funds from any Federal program exclusively
serving Indian children, or the funds reserved under any Federal program to exclusively serve
Indian children, received through a statutory or administrative formula for the purposes of
providing education and related services to serve Indian students, may be consolidated in a
demonstration project that integrates the program services involved into a single, coordinated,
comprehensive program and reduces administrative costs by consolidating administrative
functions.

20

Applicants submitting under this provision must complete the following table in lieu of tables
11-18. List the programs to be consolidated and the estimated amount of each.
Your Project’s Funding Summary for a SY 20XX-XX Application Under Section 6116
a
b
c
Program
Funding Agency
Estimated Amount

Indian Parent Committee Approval Form (IPCA Form).
This item must be completed and submitted with LEA applications and LEA consortium
applications on or before the certification deadline by uploading within the EASIE system. The
IPCA Form can be found here:

Program Assurances.
The following are the program assurances, Standard From 424B Assurances-Non-Construction
Programs and Additional Program Assurances for 84.060-Indian Education Grants. The
certifying signature of the authorizing official will indicate agreement to these provisions.
OMB Approval No. 0348-0040
Standard Form 424B

ASSURANCES - NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes
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. Send comments regarding the burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to the Office of
Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF
MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE
SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have
questions, please contact the awarding agency. Further, certain Federal awarding agencies may
require applicants to certify to additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:

21

1. Has the legal authority to apply for Federal assistance and the institutional, managerial
and financial capability (including funds sufficient to pay the non-Federal share of project
cost) to ensure proper planning, management and completion of the project described in
this application.
2. Will give the awarding agency, the Comptroller General of the United States and, if
appropriate, the State, through any authorized representative, access to and the right to
examine all records, books, papers, or documents related to the award; and will establish
a proper accounting system in accordance with generally accepted accounting standards
or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose
that constitutes or presents the appearance of personal or organizational conflict of
interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of
approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§4728-4763)
relating to prescribed standards for merit systems for programs funded under one of the
19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit
System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to nondiscrimination. These include but are
not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits
discrimination on the basis of race, color or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of
1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§61016107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the
basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the
Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee 3), as amended,
relating to confidentiality of alcohol and drug abuse patient records; (h) Title VII of the
Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to
nondiscrimination in the sale, rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s) under which application for
Federal assistance is being made; and, (j) the requirements of any other
nondiscrimination statute(s) which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles II and III of the
Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L.
91-646) which provide for fair and equitable treatment of persons displaced or whose
property is acquired as a result of Federal or federally-assisted programs. These
requirements apply to all interests in real property acquired for project purposes
regardless of Federal participation in purchases.
8. Will comply, as applicable, with provisions of the Hatch Act (5 U.S.C. §§1501-1508 and
7324-7328) which limit the political activities of employees whose principal employment
activities are funded in whole or in part with Federal funds.
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9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C.
§§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874), and the
Contract Work Hours and Safety Standards Act (40 U.S.C. §§327-333), regarding labor
standards for federally-assisted construction sub agreements.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a)
of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a
special flood hazard area to participate in the program and to purchase flood insurance if
the total cost of insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the
following: (a) institution of environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b)
notification of violating facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with
EO 11988; (e) assurance of project consistency with the approved State management
program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§1451
et seq.); (f) conformity of Federal actions to State (Clean Air) Implementation Plans
under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. §§7401 et
seq.); (g) protection of underground sources of drinking water under the Safe Drinking
Water Act of 1974, as amended (P.L. 93-523); and, (h) protection of endangered species
under the Endangered Species Act of 1973, as amended (P.L. 93-205).
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §§1271 et seq.)
related to protecting components or potential components of the national wild and scenic
rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National
Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593
(identification and protection of historic properties), and the Archaeological and Historic
Preservation Act of 1974 (16 U.S.C. §§469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in
research, development, and related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended,
7 U.S.C. §§2131 et seq.) pertaining to the care, handling, and treatment of warm blooded
animals held for research, teaching, or other activities supported by this award of
assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. §§4801 et
seq.) which prohibits the use of lead-based paint in construction or rehabilitation of
residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance
with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, "Audits
of States, Local Governments, and Non-Profit Organizations."
18. Will comply with all applicable requirements of all other Federal laws, executive orders,
regulations, and policies governing this program.
OMB Approval No. 1810-0021
Exp. Date: XX/XX/XXXX

Program Specific Assurances for 84.060 - Indian Education Formula Grants
23

As the duly authorized representative of the applicant, I certify that the applicant:
Applies to all applicants:
• Will base the program for which funds are sought on a comprehensive local assessment
and prioritization of the unique educational and culturally related academic needs of the
Indian students for whom the LEA is providing an education. (ESEA Section
6114(c)(3)(A))
• Will prepare and submit reports consistent with ESEA Section 6114(c)(2). (ESEA
Section 6114(c)(2))
• Will use the best available talents and resources, including persons from the Indian
community. (ESEA Section 6114(c)(3)(B))
• Has developed the project for which application is made in open consultation with
parents and family members of Indian children, representatives of Indian Tribes on
Indian lands located within 50 miles of any school that the agency will serve if such
Tribes have any children in such schools, teachers and, if appropriate, Indian students
from secondary schools, including through public hearings held to provide a full
opportunity to understand the program and to offer recommendations regarding the
program. (ESEA Section 6114(c)(3)(C))
• Conducted outreach to parents and family members. (ESEA Section 6114(c)(6))
• Will use the funds received only for the activities described and authorized. (ESEA
Section 6114(c)(7))
• Has set forth such policies and procedures, including policies and procedures relating to
the hiring of personnel, as will ensure that the program for which assistance is sought will
be operated and evaluated in consultation with, and with the involvement of, parents and
family members of the children, and representatives of the area, to be served. (ESEA
Section 6114(c)(8))
• Will directly administer or supervise the administration of the project. (34 CFR 75.701)
• Will keep records related to grant funds, program compliance and program performance
and will afford the Secretary access to these records as the Secretary may find necessary
to assure the correctness and verification of reports made by the applicant. (34 CFR
sections 75.730-.732)
• Has fiscal control and fund accounting procedures that insure proper disbursement of and
accounting for Federal funds. (34 CFR 75.702)
• Will submit a performance report, or, for the last year of a project, a final report, that
evaluates at least annually: (a) the grantee's progress in achieving the objectives in its
approved application; (b) the effectiveness of the project in meeting the purposes of the
program; and (c) the effect of the project on participants being served by the project. (34
CFR 75.590)
• Will cooperate in any evaluation of the program by the Secretary. (34 CFR 75.591)
Applies to LEA or an LEA(s) in consortium,
• Will use funds received under this program only to supplement the level of funds that, in
the absence of the Federal funds made available under this program, the LEA would

24

•
•
•
•

•
•

make available for services described in this application, and not to supplant such funds.
(ESEA Section 6114(c)(1))
Developed the project with the participation of a parent committee selected in accordance
with ESEA section 6114(c); and with the written approval of that parent committee.
(ESEA Section 6114(c)(4))
Has a parent committee that has adopted and will abide by reasonable by-laws for the
conduct of the activities of the committee. (ESEA Section 6114(c)(4)(D))
Will coordinate activities under this title with other Federal programs supporting
educational and related services administered by such agency (ESEA Section 6114(c)(5))
Has approval, in writing, by the parent committee for an application for inclusion of these
program funds in a Title I school-wide project, and that the parent committee was
allowed to review the application in a timely fashion, has determined that the program
will not diminish the availability of culturally related activities for Indians students,
determined that the program will directly enhance the educational experience of Indian
Students and has determined that the Title I school-wide project meets the purpose of the
Indian education formula grant program. (ESEA Sections 6114(c)(4)(C) and 6115(c))
Shall maintain fiscal effort in accordance with section 8521 of the ESEA or be subject to
reduced payments under this subpart in accordance with such section 8521 of the ESEA.
(ESEA Section 6118(c))
Prior to submitting an application to the Secretary under ESEA section 6114, submitted
the application to the State educational agency, which may comment on such application.
If the State educational agency comments on the application, the agency shall comment
on all applications submitted by local educational agencies in the State and shall provide
those comments to the respective local educational agencies, with an opportunity to
respond. (ESEA Section 6119)

Applies to applicant that is an IO, Tribe or ICBO:
• Will provide services to the eligible Indian children and is subject to all program
requirements, assurances, and obligations. (ESEA Section 6112(a)(4))
• If it is an Indian Tribe, Indian organization, or a consortium of those entities, it will use
the grant funds to provide services to all Indian students served by the local education
agency. (ESEA Section 6112(c)(3))
I certify the applicant will meet the following:
FINANCIAL MANAGEMENT
Financial management systems, including records documenting compliance with Federal
statutes, regulations, and the terms and conditions of the Federal award, will be sufficient to
permit the preparation of reports required by general and program-specific terms and conditions;
and the tracing of funds to a level of expenditures adequate to establish that such funds have
been used according to the Federal statutes, regulations, and the terms and conditions of the
Federal award. Specifically, the financial management system must be able to (1) identify, in its
accounts, all Federal awards received and expended and the Federal programs under which they
were received. Federal program and Federal award identification must include, as applicable, the
CFDA title and number, Federal award identification number and year, name of the Federal
agency, and name of the pass-through entity, if any. (2) Provide accurate, current, and complete
25

disclosure of the financial results of each Federal award or program. (3) Produce records that
identify adequately the source and application of funds for federally-funded activities. (4)
Maintain effective control over, and accountability for, all funds, property, and other assets. The
non-Federal entity must adequately safeguard all assets and assure that they are used solely for
authorized purposes. (5) Generate comparisons of expenditures with budget amounts for each
Federal award.
The applicant will have written policies and procedures for the following:
•
•
•
•
•
•
•
•
•

Cash Management (2 CFR 200.302(b)(6) & 200.305)
Determining the allowability of costs in accordance with Subpart E—Cost Principles of
this part and the terms and conditions of the Federal award. (2 CFR 200.302(b)(7))
Conflict of Interest (2 CFR 200.318(c))
Procurement (2 CFR 200.19(c))
Method Suspension and Debarment (2 CFR 200.213)
Travel Policy (2 CFR 200.474(b))
Equipment and Supplies (2 CFR 200.313(d), 200.314)
Time and Effort (2 CFR 200.430(i))
Record Keeping (2 CFR 200.333 and 200.335)

Signature of Authorized Certification Official

Title

Applicant Organization

Date

Indian Parent Committee Information
for Title VI Indian Education Formula Grant Program

LEA Name: _____________________ City _________________ State___ Zip Code ______
PR Award #: S060A20_____
Directions: All LEA applicants will upload the Indian Parent Committee Application Approval,
Indian Parent Committee Membership List and Indian Parent Committee Bylaws into the
EDFacts Submission System (ESS) before EASIE Part II closes.
Section I: Indian Parent Committee Application Approval (Note: This section is to be
completed by the Indian Parent Committee.)

26

Directions: All LEA applicants must develop the project with the participation of a parent
committee selected in accordance with ESEA section 6114(c); and with the written approval of
that parent committee. (ESEA Section 6114(c)(4)).
Attestation: The Indian Parent Committee (IPC) attests that the IPC for the above entity
participated fully in the planning and development of the application for the Indian Education
grant funds and approves the proposed program as either a regular formula grant program, Title I
Schoolwide program, or Integration of Services under ESEA Section 6116. The IPC approval
date confirms when the proposed program was approved. The IPC also attests that it had an
opportunity to review the program in a timely fashion and that the program is consistent with the
purpose of the formula grant program for Indian students. If a Title I schoolwide application was
submitted and approved by the IPC, the IPC understands that the Title VI project funds will be
combine with Title I and other federal funding. In doing so, the IPC has determined that
including project funds within a Title I schoolwide program would not diminish the availability
of culturally-related activities for Indian students. The IPC determined that the program will
directly enhance the educational experience of Indian students. (ESEA Sections 6114(c)(4)(C)
and 6115(c))
IPC Approval Date: _______________________
Printed Name of Title VI Parent Committee Chairperson/Designee
_________________________________
Signature of Title VI Parent Committee Chairperson/Designee
_____________________________________
Section 2: Indian Parent Committee (IPC) Membership List (Note: This section to be
completed by either the IPC or the LEA applicant.)
Directions: All LEA applicants will provide a list of printed names of all current members of the
IPC. ESEA section 6114(c)(4) requires the IPC to be comprised of parents and family
members of Indian children in the LEA's schools; representatives of Indian tribes on Indian
lands located within 50 miles of any school that the agency will serve if such tribes have any
children in such school; teachers in the schools; and if appropriate, Indian students attending
secondary schools of the agency. More than one-half of the total number of Indian Parent
Committee members must be parents and family members of eligible Indian children.
Parents and family members

Tribal members, if applicable

Teachers

Students

27

Section 3: Indian Parent Committee (IPC) Bylaws
Directions: All LEA applicants will upload a copy of the IPC Bylaws into the ESS. The LEA
assures the IPC will adopt and abide by reasonable bylaws for the conduct of the activities of the
committee. (ESEA Section 6114(d))

28