BIE-62107 Tribal Colleges and Universities Grant Application Form

BIE Form 62107

OMB Control No. 1076-0018
Expires: xx/xx/xxxx

TRIBAL COLLEGES & UNIVERSITIES GRANT APPLICATION FORM
25CFR 41.8, Public Law 95-471 (as amended)
Information and General Instructions: The application is due annually on or before June 1st. This information is collected to
meet the reporting requirements. Response to this request is required by Public Law 95-471, as amended. The information
collected is subject to the Paperwork Reduction Act. An agency may not request nor sponsor, and a person need not answer, a
request for information that does not contain a valid OMB control number. A response to this request is required to obtain or
retain a benefit and no action may be taken against the institution’s refusal to supply the information if there is no valid OMB
Control Number. The public reporting burden for this form is estimated to average eleven (11) hours per response, including the
time for reviewing instructions, gathering and maintaining data, and completing and reviewing this form. Send comments
regarding the burden estimate or any other aspect of this form to the Bureau ICCO, Indian Affairs, 1001 Indian School Road
NW, Suite 229, Albuquerque, NM 87104.

Name of College or University

IRS No.

___________________________________________________________________________
Mailing Address

_____________________________

________________

_______________

Accreditation By

Accreditation Type

Approving Organization

BOARD OF DIRECTORS
We, the Board of Directors, declare the institution does not deny admission to any Indian student based upon the
criteria and definitions set forth in 25 CFR 41.11; nor do we waive the requirements of 25 CFR41 .

Chairperson _______________________________

Member _________________________

Vice Chair ________________________________

_________________________

_________________________

_________________________

_________________________

Number of College governing board:

Indian ______

Non-Indian:

Indian Student Count (ISC) for the previous academic term:
Summer ISC:__________Fall ISC:__________Winter ISC:__________Spring ISC:__________

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BIA Form 62107

OMB Control No. 1076-0018
Expires: XX/XX/XXXX

ENROLLMENT INFORMATION: Degrees Granted
Master Arts/Master Science
Bachelor Arts/Science
Associate Arts/Science
Two Year Certificate

__________
__________
__________
__________

Average Class Size
No. of Instructors
FTE Instructors
PTE Instructors

I hereby certify the information contained within this application is complete and accurate.

Chairman of the Board

Date

Institution’s President

Date

I hereby certify that

has met all of the eligibility
Name of Institution

requirements for continued funding authorized by Public Law 95-471, as amended.

Director, Office of Indian Education Programs

Date

Chief, Division of Contracts & Grants Administration

Date

REQUIRED ATTACHMENTS:

1.

2.

3.

A proposed budget showing total expected operating expenses in the following education
categories: (a) Personnel, (b) Instruction, (c) Administration, (d) Other, and (e) Total.
The total expected revenues from all sources for the academic year.
A copy of the institution’s policy statement, Charter, By-Laws, and catalog which
includes a copy of the institution’s current curriculum, or other document wherein is
found the goals, philosophy or plan of operation to meet the needs of Indian students.
A description of the accounting procedures used for grants received under Pub. L. 95471.

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