Impact Aid Discretionary Grant Application

FORM APPROVED
OMB Number xxxx-xxx
Expiration: xx/xx/xxxx

APPLICATION FOR IMPACT AID DISCRETIONARY CONSTRUCTION PROGRAM – SECTION 7007(b)
LOCAL EDUCATIONAL AGENCY (LEA) INFORMATION
Contact the Local Tax Assessor for help with the table below. Charter schools, Alaska Regional
Educational Attendance Areas (REAAs), and LEAs that share the same exact boundaries as a Federal
Property may enter 0 for both questions.
LEA Name

Total Acres Within the Boundaries of the LEA

Total Acres of Non-Taxable Federal Property
Within the Boundaries of the LEA

Contact the State Educational Agency, Local Treasurer, or Local Assessor for help with the table below.
Name of Taxing Jurisdiction (e.g., School District
Total Assessed Value of Real Property (Land and
Name, Township Name, City Name, County
Improvements) That Was Taxed for School
Name, etc.)
Purposes for school year 2023-2024 on Behalf of
the LEA

GRAND TOTAL:

$0

Contact your State Educational Agency for help with the table below. If the State does not have
limitations on the amount your LEA can bond, your Maximum Bonding Capacity is 10% of the Total
Assessed Value Grand Total from the table above. If the Total Assessed Value Grand Total in the table
above is less than $25,000,000, enter $0 for both.
Maximum Bonding Capacity as of the end of
Amount of Bonded Debt as of the end of school
school year 2023-2024
year 2023-2024

FORM APPROVED
OMB Number xxxx-xxx
Expiration: xx/xx/xxxx

APPLICATION FOR IMPACT AID DISCRETIONARY CONSTRUCTION PROGRAM – SECTION 7007(b)
SCHOOL FACILITY FOR WHICH FUNDING IS REQUESTED
Name of the School
Current Address of the School

Approximate Square Feet of New Construction (if
applicable)

Location of Proposed Project (if different from
current address)

Proposed Project Start Date

Proposed Project End Date

Own

Year of Original Construction
Year(s) of Major Renovation(s)

Interest in the Current School Facility
Lease
(Give expiration date below.)

Other
(Explain below.)

History of Current School Facility
Description of Major Renovation

Fill in the table below only if your LEA has multiple educational facilities. If your LEA has one facility,
we will obtain this information from the Impact Aid, Section 7003 application.
Percentage of Federally Connected Children in the School Facility
Total Enrollment in the School
Number of Children with a
Number of Children Living on
Facility on the School Year
Parent in the Uniformed
Indian Lands in the School
2023-2024 Impact Aid Survey
Services in the School Facility on Facility on the School Year
Date
the School Year 2023-2024
2023-2024 Impact Aid Survey
Impact Aid Survey Date
Date

FORM APPROVED
OMB Number xxxx‐xxx
Expiration: xx/xx/xxxx

APPLICATION FOR IMPACT AID DISCRETIONARY CONSTRUCTION PROGRAM – SECTION 7007(b)
PROJECT NARRATIVE FOR EMERGENCY GRANTS
If the space provided is insufficient, you may upload a project narrative as a Word or PDF document.
Describe the
emergency condition
in the current school
facility and the
importance of the
affected area to the
instructional
program.

Describe which
building occupants
are affected, and
how the emergency
condition adversely
affects health, safety,
and well‐being.

FORM APPROVED
OMB Number xxxx‐xxx
Expiration: xx/xx/xxxx

APPLICATION FOR IMPACT AID DISCRETIONARY CONSTRUCTION PROGRAM – SECTION 7007(b)
PROJECT NARRATIVE FOR EMERGENCY GRANTS ‐ CONTINUED
Describe the age of
the facility systems
associated with this
project (e.g., roofing,
plumbing, HVAC,
windows, electrical,
etc.).

Describe the actions
the applicant has
taken to respond to
the emergency
condition.

FORM APPROVED
OMB Number xxxx‐xxx
Expiration: xx/xx/xxxx

APPLICATION FOR IMPACT AID DISCRETIONARY CONSTRUCTION PROGRAM – SECTION 7007(b)
PROJECT NARRATIVE FOR EMERGENCY GRANTS ‐ CONTINUED
Describe why the
applicant has been
unable to resolve the
condition.

Describe the
proposed project
scope, including a
timeline of major
activities such as
design, contract
solicitation and
award, and
construction start
and end dates.

FORM APPROVED
OMB Number xxxx‐xxx
Expiration: xx/xx/xxxx

APPLICATION FOR IMPACT AID DISCRETIONARY CONSTRUCTION PROGRAM – SECTION 7007(b)
PROJECT NARRATIVE FOR EMERGENCY GRANTS ‐ CONTINUED
Describe how the
proposed project will
address the
emergency
condition.

Describe the
potential effects of
delaying the project.

FORM APPROVED
OMB Number xxxx‐xxx
Expiration: xx/xx/xxxx

APPLICATION FOR IMPACT AID DISCRETIONARY CONSTRUCTION PROGRAM – SECTION 7007(b)
JUSTIFICATION FOR REBUILDING – IF APPLICABLE
If the proposal is for
new construction,
give a justification for
rebuilding instead of
repairing or
renovating the
existing school
facility.

OMB Form xxxx-xxx
Expiration: xx/xx/xxxx
Click here for burden statement.

APPLICATION FOR DISCRETIONARY CONSTRUCTION PROGRAM - SECTION 7007(b)
COST ESTIMATE TABLE
Please provide an itemized estimate of the proposed project cost by source of funds.
Impact Aid
State, Local, or Other
Construction Funds
Federal Funds
Budget Category
Total
(a) Direct Project Costs
$ 0.00
$ 0.00
$ 0.00
$ 0.00
Supplies
$ 0.00
Equipment
$ 0.00
Advertisements
$ 0.00
Travel/Expenses
(b) Planning, Design, Engineering,
Environmental Impact Study
$ 0.00
$ 0.00
$ 0.00
$ 0.00
Facilities plan
$ 0.00
Environmental Documentation
$ 0.00
Plans and Specifications
$ 0.00
Bid Documents
$ 0.00
Engineering Services
(c) Construction
$ 0.00
$ 0.00
$ 0.00
$ 0.00
Construction Management
$ 0.00
Labor*
$ 0.00
Materials**
$ 0.00
Equipment
Other (specify below)
$ 0.00

(d) Miscellaneous
Permits
Compliance
Taxes
Other (specify below)

$ 0.00

(e) Total Project Cost***

$ 0.00

$ 0.00

$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00

$ 0.00

$ 0.00

*Impact Aid Discretionary Construction Grants are subject to the Davis-Bacon Act (40 U.S.C. 3141 et seq. ),
which establishes Federal minimum wage rates for construction labor for your locality.
**Build America, Buy America Act: This program is subject to the Build America, Buy America Act (Pub. L. 117-58)
domestic sourcing requirements. Accordingly, under this program, grantees and their subrecipients (subgrantees)
and contractors may not use their grant funds for infrastructure projects or activities (e.g., construction,
remodeling, and broadband infrastructure) unless--(a) All iron and steel used in the infrastructure project or
activity are produced in the United States; (b) All manufactured products used in the infrastructure project or
activity are produced in the United States; and (c) All construction materials are manufactured in the United
States. Grantees may request waivers to these requirements by submitting a Build America, Buy America Act
Waiver Request Form. For more information, including a link to the Waiver Request Form, see the Department’s
Build America Buy America Waiver website at: https://www2.ed.gov/policy/fund/guid/buyamerica/index.html. Grantees may request a waiver for these requirements, but do not assume a waiver

request will be granted when creating your cost estimate.

***Ensure the total cost agrees with the response to question 18 on the SF-424 form. The program
regulations at 34 C.F.R. §§222.191-192 may require a local share.

FORM APPROVED
OMB Number xxxx-xxx
Expiration: xx/xx/xxxx

APPLICATION FOR IMPACT AID DISCRETIONARY CONSTRUCTION PROGRAM – SECTION 7007(b)
INDEPENDENT CERTIFICATION FOR EMERGENCY GRANTS
This form must be completed and signed by a local building inspector, a licensed architect, or a
licensed engineer, and included as part of an emergency application for the discretionary construction
program. The person providing this certification cannot be a member of the applicant’s staff.
Name
Title
Organization
Email Address

Phone Number

For the school facility named in this application, please:
1. Provide your professional and independent assessment of whether the condition is an
emergency;
2. Describe how the condition adversely affects the health, safety and well-being of occupants
of the school facility;
3. Describe the urgency of the need to address the condition; and
4. Provide any additional comments you believe are relevant.
If you need more space, you may provide a signed letter that includes your contact information and
your signature for the applicant to upload with the application.

I certify that these statements
are, to the best of my
knowledge and belief, true,
complete and correct.

Signature

Date

FORM APPROVED
OMB Number xxxx-xxx
Expiration: xx/xx/xxxx

APPLICATION FOR IMPACT AID DISCRETIONARY CONSTRUCTION PROGRAM – SECTION 7007(b)
PROGRAM ASSURANCES AND CERTIFICATIONS
The applicant local educational agency (LEA) declares that it has filed the three certifications
regarding lobbying, debarment/suspension/responsibility status, and drug-free workplace with the
U.S. Department of Education (Department) as part of its section 7003 or section 7002 Impact Aid
application. As of the date of the signature below, the LEA reaffirms and incorporates by reference
those assurances and certifications with respect to this grant award. The LEA certifies that no
circumstances affecting the validity of these assurances have changed since their previous filing.
With respect to the Certification Regarding Lobbying, the LEA recertifies that no Federal appropriated
funds have been paid or will be paid to any person for influencing or attempting to influence an
officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with the making or renewal of Federal grants under
this program; that the LEA shall complete and submit Standard Form-LLL, "Disclosure Form to Report
Lobbying," when required (34 C.F.R. Part 82, Appendix B); and that the LEA shall require the full
certification, as set forth in 34 C.F.R. Part 82, Appendix A, in the award documents for all subawards
at all tiers.

The LEA further agrees to comply with 2 CFR Part 200 -- Uniform Administrative
Requirements, Cost Principles, and Audit Requirements for Federal Awards and the following
Education Department General Administrative Regulations (EDGAR):
34 CFR Part 75 -- Direct Grant Programs, except 75.600 through 75.617
34 CFR Part 77 -- Definitions that Apply to Department Regulations
34 CFR Part 81 -- General Education Provisions Act--Enforcement
34 CFR Part 82 -- New Restrictions on Lobbying
34 CFR Part 84 -- Governmentwide Requirements for Drug –Free Workplace (Grants)
34 CFR Part 85 -- Governmentwide Debarment and Suspension (Nonprocurement)
Signature of Authorized Representative

Date

FORM APPROVED
OMB Number xxxx-xxx
Expiration: xx/xx/xxxx

APPLICATION FOR IMPACT AID DISCRETIONARY CONSTRUCTION PROGRAM – SECTION 7007(b)
ADDITIONAL DEPARTMENT OF EDUCATION CONSTRUCTION ASSURANCES
The applicant local educational agency (LEA) further certifies that it will ensure that:
21. It has or will have title or other interest in the project site(s), including right of access, and that the site(s) will
continue to be used for educational purposes after the completion of the project(s).
22. Sufficient funds are available to meet any share of the costs of the repair, renovation, or construction projects that
are not covered by this grant.
23. Except for school facilities modifications necessary to render public school facilities accessible in order to comply
with the Americans with Disabilities Act (ADA) of 1990 or section 504 of the Rehabilitation Act of 1973, this grant
will be used only to supplement the amount of funds that in the absence of the Federal funds would be made
available from non-Federal sources for school repair and renovation.
24. Except for modifications necessary to meet ADA or section 504 of the Rehabilitation Act standards and asbestos
abatement or removal, the grant will not be used for repair, renovation, or construction of facilities or any part of
a facility that will be used for religious worship, instruction, or proselytization.
25. Competent architectural engineering supervision and inspection will be maintained at the project’s site to ensure
that the work conforms to the drawings and specifications for the approved project.
26. Grant projects will be: (a) functional; (b) economical; and (c) not elaborate in design or extravagant in the use of
materials, compared with the facilities of a similar type constructed in the State or other applicable geographical
area.
27. Standards under the Occupational Safety and Health Act of 1970 (P.L. 91-576), or State and local codes, if they are
more stringent, will be observed in the design and completion of the projects.
28. Grant projects will comply with any applicable requirements under the ADA and section 504 of the Rehabilitation
Act of 1973 regarding accessibility for the disabled.
29. As applicable and to the extent feasible, the design and completion of grant project(s) should maximize efficient
use of energy. Standard 90.1-1989 and 90.2-1993 of the American Society of Heating, Refrigerating, and AirConditioning Engineers, Inc. (ASHRAE) will be applied in the design and completion of the grant projects.
30. It will follow the "Earthquake Hazards Reduction Act of 1977" (P.L. 95-125) and Executive Order 12699, "Seismic
Safety of Federal and Federally Assisted or Regulated New Building Construction," as applicable.
31. If applicable, it will comply with the following Indian Preferences and Opportunities requirements. Section 7(b) of
the Indian Self-Determination and Education Assistance Act of 1975 (P.L. 93-638) requires that, to the greatest
extent feasible, the recipient of any grant or contract awarded for the benefit of Indians give to: (1) Indians,
preferences and opportunities for training and employment in connection with the administration of the grant or
contract; and (2) Indian organizations and Indian-owned economic enterprises, as defined in section 3 of the
Indian Financing Act of 1974 (P.L. 93-262), preference in the award of contracts and subcontracts at any level of
the administration of the grant project.
32. If it carries out repair, renovation, or construction through a contract, any such contract process ensures the
maximum number of qualified bidders, including small, minority, and women-owned businesses, through full and
open competition.
33. The facilities will be operated and maintained in accordance with applicable Federal, State, and local
requirements.
34. When the project is completed, sufficient operational funds will be available for effective operation and
maintenance of the facilities.
35. Funds received under this program will not be used to supplant other available non-Federal construction money.
36. The grantee shall conduct and submit a Feasibility of Construction report to the Department prior to commencing
new construction demonstrating that the area upon which the construction will take place is suitable for
construction and will be able to sustain the new facility or addition.

Signature of Authorized Representative

Date