Sample application template from SEA to non-public schools_1-13-21

This template is an example that a State educational agency (SEA) may use when developing the application that it will require non-public schools to submit to receive services or assistance through the Emergency Assistance to Non-Public Schools (EANS) program under the Coronavirus Response and Relief Supplemental Appropriations Act, 2021 (CRRSA Act). An SEA is not required to use this template.

EMERGENCY ASSISTANCE TO NON-PUBLIC SCHOOLS PROGRAM 

 

PART A:  Cover Sheet 

 

Name of School:
Mailing Address (Street Number and Name, City, State, Zip Code):      Email Address of Authorized Representative of the School:
I certify to the best of my knowledge and belief, all of the information in this application is true and correct. I further understand that knowingly making a false statement or misrepresentation on this application may subject me to criminal or civil penalties under applicable State and Federal laws.
Authorized Representative of the School (Typed Name):	Telephone:
Signature of Authorized Representative of the School:	Date:

PART B: Non-Public School Eligibility

By checking each box below, I affirm that the following is true and correct regarding my school.

☐ The school requesting services or assistance is a non-profit school.

☐ The school requesting services or assistance is accredited, licensed, or otherwise approved to operate in accordance with State law.

☐ The school requesting services or assistance existed and operated prior to March 13, 2020.

☐ The school requesting services or assistance did not and will not apply for and receive a loan under the Small Business Administration’s Paycheck Protection Program (PPP) (15 U.S.C. 636(a)(37)) that is made on or after December 27, 2020.

NOTE: If a non-public school applies for a PPP loan on or after December 27, 2020, but does not receive funds under the PPP, the school may apply for services or assistance under the EANS program, as long as the non-public school meets the requirements and deadlines of this application. If a non-public school applied for or received a PPP loan prior to December 27, 2020, it remains eligible for the EANS program. Similarly, if a non-public school applies for but does not receive services or assistance through EANS, nothing in the Education Stabilization Fund would preclude that non-public school from applying for and receiving a PPP loan on or after December 27, 2020.

☐ None of the services or assistance for which I am requesting support in Part D of this application have already been supported by a loan under the PPP.

[At its discretion, an SEA may require a non-public school applicant to submit reasonable and appropriate documentation to substantiate one or more of the above assurances.]

PART C: Non-Public School Data

Section 312(d)(3)(C) requires an SEA to prioritize services or assistance to non-public schools that enroll low-income students and are most impacted by COVID-19. Accordingly, the State requests that the school provide the data described below. Such data must not include personally-identifiable information about students or their families.

1. Enrollment and Low-Income Data

1. Total student enrollment of the school in the 2019-2020 school year: _______

2. Number or estimated number of students from low-income families enrolled in the school in the 2019-2020 school year: _____________

This number or estimated number is from the following data source(s): ______________ [The non-public school should insert the sources the school used from among those the SEA indicated it will accept.]

The SEA will accept _________________________ [SEA should list the data sources and sources of estimates the SEA will accept for this item. For additional information, an SEA should see Appendix A.]

3. Percentage or estimated percentage of total students in the school who are students from low-income families (i.e., 1.B/1.A): ______ %

2. Paycheck Protection Program (PPP)

1. Did the school receive a loan guaranteed under the PPP before December 27, 2020?

☐ Yes.

☐ No.

2. If the answer to 2.A is yes, please respond to the following:

1. What was the total amount of the PPP loan? $______________

2. Do you assure that any funds received under the EANS program will be services or assistance not already funded by the PPP loan?

☐ Yes.

☐ No.

3. Impact of COVID-19

[The State may request any reasonable information from a non-public school to describe and/or quantify the impact of COVID-19 on the non-public school. Factors that an SEA might consider in determining non-public schools that are most impacted by COVID-19 include but are not limited to: (1) loss of tuition revenue; (2) decrease in enrollment; (3) lack of capacity to provide remote learning due to insufficient technological support, and (4) data documenting the extent of learning loss attributable to the educational disruptions caused by COVID-19.]

[Optional] 4. Whether the Non-Public School Received Equitable Services Under the CARES Act

Did the school receive equitable services from an LEA under the CARES Act?

☐ Yes.

☐ No.

PART D: Non-Public School Services or Assistance Requested

A non-public school may apply to receive services or assistance from the SEA or its contractors to address educational disruptions resulting from COVID-19 for:

• Supplies to sanitize, disinfect, and clean school facilities

• Personal Protective Equipment (PPE)

• Improving ventilation systems, including windows or portable air purification systems

• Training and professional development for staff on sanitization, the use of PPE, and minimizing the spread of infectious diseases

• Physical barriers to facilitate social distancing

• Other materials, supplies or equipment recommended by the CDC for reopening and operation of school facilities to effectively maintain health and safety

• Expanding capacity to administer coronavirus testing to effectively monitor and suppress the virus

• Educational technology

• Redeveloping instructional plans for remote or hybrid learning or to address learning loss

• Leasing sites or spaces to ensure social distancing

• Reasonable transportation costs

• Initiating and maintaining education and support services or assistance for remote or hybrid learning or to address learning loss

• Reimbursement for the expenses of any services or assistance described above that a non-public school incurred on or after March 13, 2020, except for:

• Improvements to ventilation systems (including windows), except for portable air purification systems, which may be reimbursed.

• Staff training and professional development on sanitization, the use of PPE, and minimizing the spread of COVID-19.

• Developing instructional plans, including curriculum development, for remote or hybrid learning or to address learning loss.

• Initiating and maintaining education and support services or assistance for remote or hybrid learning or to address learning loss.

• Any expenses reimbursed through a loan guaranteed under the PPP (15 U.S.C. 636(a)) prior to December 27, 2020.

For additional information on allowable services or assistance, please see the Frequently Asked Questions posted online at [insert link to FAQs].

Table 1: Requests for Reimbursement of Previous Expenses:

Service or Assistance	Description	Dollar amount
TOTAL	n/a	[Sum of lines above]

[NOTE: To maintain control over the EANS funds, the SEA must ensure that the non-public school’s expenditures are allowable expenses, that the non-public school has sufficient documentation supporting such expenditures, and that the SEA or another public agency gains title to materials, equipment, and property for which it provides reimbursement. Thus, the SEA may require any reasonable documentation, such as paid invoices or receipts, related to items for which a non-public school is requesting reimbursement. The SEA may also request this information, and that requested in Table 2 of this document, in narrative or list format.]

Table 2: Requests for Future Services or Assistance (or Reimbursement of Future Expenses)

Service or Assistance	Description	Anticipated approximate dollar amount
TOTAL	n/a	[Sum of lines above]

[Optional] If the non-public school chooses to include any attachments, please consider using a table of contents, which could be in the below format or another format.

Table of Contents for Appendix or Attachments

[Identify each attachment, if any, and the page number on which it can be found.]

Attachment Name/Number	Page

Appendix A: Information for an SEA Regarding Calculating the Number of Students from Low-Income Families [An SEA need not include this Appendix in its application.]

The SEA has discretion to identify the data source(s) it will accept when calculating the number of students enrolled in a non-public school in school year 2019-2020 who are from low-income families. The SEA also has discretion in determining what it means for a family to have a low income (i.e., the SEA sets a particular threshold, which could be a percentage of the Federal poverty level or another amount). The SEA should make such information readily available and ensure that the definition of “low-income” it uses is the same for all non-public schools. The SEA should select reliable source(s) of data that are least burdensome on non-public schools and families and may permit the use of multiple data sources.

To the extent non-public schools have the following readily available, possible data sources might include:

• free or reduced-price lunch data,

• scholarship or financial assistance data,

• E-Rate data, or

• other relevant data, such as data that the non-public school has provided to the State for purposes of State or local programs.

For non-public schools where such data are not readily available, and in order to avoid new or unnecessary data collections from non-public schools and families, the following are potential sources of estimates of the number of students from low-income families:

• data imputing the number of students from low-income families based on the American Community Survey (ACS) or the Small Area Income and Poverty Estimates (SAIPE) program by the U.S. Census Bureau,¹or

• proportionality data: the number of students enrolled in a non-public school who reside in a Title I school attendance area multiplied by the percentage of public school students in that same attendance area who are from low-income families. If the non-public school has students who reside in more than one Title I school attendance area, multiple calculations would be necessary.

1 If using ACS data, the SEA might request that the non-public school determine the number of enrolled students in the 2019-2020 school year that resided in particular Census tracts. Information about identifying the Census tract of a particular address is available at https://www2.census.gov/data/api-documentation/Address%20Search%20-%20Geocoder%20and%20TIGERweb/How%20to%20Find%20Geo%20Info%20from%20Address.pdf. The SEA could then apply the ACS data about the poverty rate in each of those Census tracts to estimate the number of students from low-income families enrolled in the school. This method will work best when most students at a non-public school live in a small number of Census tracts. If using this approach, an SEA could include the table below in Part C.1.B.

Census Tract Number	Number of Enrolled Students in the 2019-2020 School Year

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