1810-0646 Form3_RLIS-SQA_LEA_Instrument_FY23

U.S. Department of Education

Office of Elementary and Secondary Education

Rural, Insular, and Native Achievement Programs Division

Washington, D.C. 20202

Form 3

Fiscal Year 2023

Application for New Grants for Specially Qualified Agencies Under the Rural and Low-Income School Program

ALN 84.358C

Dated Material - Open Immediately

Closing Date:

Approved OMB Number: 1810-0646

Expiration 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. The valid OMB control number for this information collection is 1810-0646. Public reporting burden for this collection of information is estimated to average 0.5 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 benefit, per Part B of Title V of the Elementary and Secondary Education Act (ESEA), reauthorized by the Every Student Succeeds Act (ESSA), signed into law in December 2015. If you have comments or concerns regarding the status of your individual submission of this application, please contact the Office of Elementary and Secondary Education’s Rural Education Achievement Program at [email protected] or 202-401-0039 directly. [Note: Please do not return the completed application to this address.]

Application Submission Procedures

Application Transmittal Instructions

Attention Electronic Applicants: This program requires the electronic submission of applications. Specific requirements and instructions can be found in the Federal Register notice. Please note that you must follow the application procedures described in the Federal Register Notice of Application Deadline.

Application Instructions

Electronic Application Format

Applications for grants must be submitted electronically, unless submitted pursuant to an exception to the electronic submission requirement in accordance with the instructions in the Federal Register notice.

Specially Qualified Agencies (SQA) Application Items

Item 1: Local Educational Agency (LEA) Name and Mailing Address– Enter the name, mailing address, and phone number of the LEA that is applying for the grant.

Item 2: Unique Entity Identify (UEI) – Enter the UEI number assigned to the LEA. (NOTE: UEIs are a mix of letters and numbers and an LEA will be unable to access any awarded RLIS grant funds unless this UEI number is active and registered with the System for Award Management (SAM)).

Item 3: LEA Authorized Representative Contact – Enter the name, title, email address, and phone number of the authorized representative. The authorized representative is the legally responsible person for the RLIS grant and will be the primary point of contact. The authorized representative will receive communication from the G5.gov system and the U.S. Department of Education and receive the Grant Award Notification (GAN).

Item 4: LEA Secondary Contact – Enter the name, title, email address, and phone number of an official within the LEA that is different from the authorized representative contact. The LEA secondary contact is an additional point of contact between the LEA and the U.S. Department of Education. Both the authorized representative and the secondary contact will receive the GAN, communication emails from the G5.gov system, and can request access to draw down RLIS funds from G5.gov.

Item 5: GEPA Statement – Section 427 of the General Education Provisions Act (GEPA) requires U.S. Department of Education grantees, such as RLIS grantees, to describe the steps the grantee will take to ensure equitable access to, and participation in, the Federally assisted program by addressing the special needs of students, teachers, and other program beneficiaries. This provision allows applicants discretion in developing the required description. The statute highlights six types of barriers that can impede equitable access or participation: gender, race, national origin, color, disability, or age. Based on local circumstances, an LEA should determine whether these or other barriers may prevent students, teachers, or other program beneficiaries from such access or participation in the Federally funded project or activity. Enter the LEA’s GEPA statement, describing the steps the LEA will take to ensure equitable access to, and participation in, the program and/or activities assisted by the RLIS grant.

Item 6: Intended Use of Funds –Enter a brief description of the LEA’s intended use(s) of RLIS funds. Note that you can submit the intended or projected use of RLIS funds; this is not a binding agreement regarding the use of RLIS funds and an LEA can change how it uses RLIS funds at any point during the performance period without updating its application, as long as the use is allowable in accordance with RLIS program requirements. An LEA may use RLIS funds to pay for activities that are allowable under Title I, Part A; Title II, Part A; Title III; and Title IV, Part A of the Elementary and Secondary Education Act of 1965, as amended (ESEA), as well as parent and family engagement activities. RLIS funds must be used to supplement, and not supplant, any other Federal, State, or local education funds.

Item 7: Attestation/Signature and Date – The authorized representative must sign and date the application where indicated; by doing so, the authorized representative attests that the information entered on this form is true and accurate to the best of his/her/their knowledge.

Item 8: Average Daily Attendance (only collected from applicants if State educational agency does not submit data via Form 1) – Results of the census conducted to determine the number of students in average daily attendance in kindergarten through grade 12 at the schools served by each LEA. The census must be conducted not earlier than the start of the school year and not later than December 1. Average daily attendance (ADA) from the census conducted during the school year preceding the Federal fiscal year (FY) in which the data are collected is used to calculate allocation amounts for the upcoming awards (e.g., school year 2021-2022 ADA is collected in the Fall of 2022 and determines FY 2023 awards (awards made in July 2023)). The Annual Average Daily Attendance Census Determination is described in Part B, Subpart 3, section 5231 of the Elementary and Secondary Education Act of 1965 (ESEA):

‘‘SEC. 5231. ANNUAL AVERAGE DAILY ATTENDANCE DETERMINATION.

‘‘(a) CENSUS DETERMINATION.— Each local educational agency desiring a grant under section 5212 and each local educational agency or specially qualified agency desiring a grant under subpart 2 shall —

‘‘(1) not later than December 1 of each year, conduct a census to determine the number of students in average daily attendance in kindergarten through grade 12 at the schools served by the agency; and

‘‘(2) not later than March 1 of each year, submit the number described in paragraph (1) to the Secretary (and to the State educational agency, in the case of a local educational agency seeking a grant under subpart (2)).

Item 9: Funds Provided Under Part A of Title II (only collected from applicants if State educational agency does not submit data via Form 1) – For each LEA, enter the total amount of funds received through ESEA Title II, Part A of the ESEA during the school year preceding the fiscal year during which data are collected. In other words, for the FY 2023 REAP awards to be made in July 2023, the Department will use SY 2021-2022 LEA award amounts, which were made out of an SEA’s FY 2021 Title II, Part A allocation. If an LEA did not receive Title II, Part A funding, the allocation for that LEA should be left blank.

Item 10: Funds Provided Under Part A of Title IV (only collected from applicants if State educational agency does not submit data via Form 1) – For each LEA, enter the total amount of funds received through Title IV, Part A of the ESEA during the school year preceding the fiscal year during which data are collected. In other words, for the FY 2023 REAP awards to be made in July 2023, the Department will use SY 2021-2022 LEA award amounts, which were awards made out of an SEA’s FY 2021 Title IV, Part A allocation. If an LEA did not receive Title IV, Part A funding, the allocation for that LEA should be left blank.

Item 11: State Rural Definition (only collected from applicants if State educational agency does not submit data via Form 1) – For an LEA that is located in an area defined as rural by a governmental agency of the State, the SEA must submit the State definition of rural for the purposes of REAP. Specifically, if there is an applicable definition of rural by a governmental agency of the State, the SEA must provide the following information:

1. The identity of the State governmental agency that established the definition;

2. A copy of the rural definition; and

3. The SEA’s concurrence that the use of the definition and the applicable list of LEAs is accurate for the Small, Rural School Achievement (SRSA) or RLIS program.

Item 12: Operational Status (only collected from applicants if State educational agency does not submit data via Form 1) – Confirm the operational status of each LEA, including any current or planned change in an LEA’s operational status (e.g., LEA closure, merger, separation, etc.) during the period of the award (e.g., for FY 2023 awards, the period would be July 1, 2023, to September 30, 2025).

Item 13: LEA and School Virtual Designation (only collected from applicants if State educational agency does not submit data via Form 1) – Confirm the virtual designation of an LEA by indicating if the LEA is fully virtual or if one or more schools within the LEA are fully virtual. Schools that are full virtual centers (i.e., all instruction offered by the school is virtual, although students and teachers may meet in person for field trips, school-sponsored social events or assessment purposes; all students receive all instruction virtually) are ineligible to generate or benefit from REAP funding. In order to ensure that funds are not generated by or obligated for full virtual students, the ADA generated by any virtual school within an LEA must be excluded from the total ADA for the LEA. Note that primarily virtual schools (i.e., the school’s major purpose is to provide virtual instruction to students, but some traditional classroom instruction is also provided; most students receive all instruction virtually), supplemental virtual schools (i.e., instruction is directed by teachers in a traditional classroom setting and virtual instruction supplements face-to-face instruction by teachers; students vary in the extent to which their instruction is virtual), and non-virtual schools (the school does not offer any virtual instruction; no students receive any virtual instruction) are included in the ADA for eligibility determination.

Item 13: SQA Objectives and Outcomes – Under the ESEA, section 5223(b)(1), an SQA must provide to the Department its RLIS objectives and outcomes for allowable activities under the program, including how it will use such funds to help all students meet the challenging State academic standards.

ii