Application for Grants under the Upward Bound Program - Public Institutions

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OMB Number: 4040-0004
Expiration Date: 12/31/2022

Application for Federal Assistance SF-424
* 1. Type of Submission:

* 2. Type of Application:
* If Revision, select appropriate letter(s):
Preapplication Application
Changed/Corrected Application
New
Continuation	* Other (Specify):
Revision
* 3. Date Received:	4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier:
State Use Only:
6. Date Received by State:
7. State Application Identifier:
8. APPLICANT INFORMATION:
* a. Legal Name:
* b. Employer/Taxpayer Identification Number (EIN/TIN):
* c. Organizational DUNS:
d. Address:
    • Street1: Street2:
    • City: County/Parish:
    • State: Province:
    • Country:	USA: UNITED STATES
    • Zip / Postal Code:
e. Organizational Unit:
Department Name:
Division Name:
f. Name and contact information of person to be contacted on matters involving this application:
Prefix:

Middle Name:
* Last Name: Suffix:

* First Name:











Title:
Organizational Affiliation:
* Telephone Number:	Fax Number:
* Email:


Application for Federal Assistance SF-424
* 9. Type of Applicant 1: Select Applicant Type:

Type of Applicant 2: Select Applicant Type:

Type of Applicant 3: Select Applicant Type:

* Other (specify):
* 10. Name of Federal Agency:
11. Catalog of Federal Domestic Assistance Number:

CFDA Title:
* 12. Funding Opportunity Number:

* Title:
13. Competition Identification Number:

Title:
14. Areas Affected by Project (Cities, Counties, States, etc.):


Add Attachment


Delete Attachment


View Attachment
* 15. Descriptive Title of Applicant's Project:
Attach supporting documents as specified in agency instructions.
Add Attachments	Delete Attachments	View Attachments

Application for Federal Assistance SF-424

    16. Congressional Districts Of:
    • a. Applicant


    • b. Program/Project

Attach an additional list of Program/Project Congressional Districts if needed.
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    17. Proposed Project:
    • a. Start Date:	* b. End Date:

    18. Estimated Funding ($):

    • a. Federal

    • b. Applicant

    • c. State

    • d. Local

    • e. Other

    • f. Program Income

    • g. TOTAL

    • 19. Is Application Subject to Review By State Under Executive Order 12372 Process?
        a. This application was made available to the State under the Executive Order 12372 Process for review on	.
        b. Program is subject to E.O. 12372 but has not been selected by the State for review.
        c. Program is not covered by E.O. 12372.

    • 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.)
Yes	No

If "Yes", provide explanation and attach
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21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)
** I AGREE

** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions.

Authorized Representative:

Prefix:	* First Name:

Middle Name:

    • Last Name: Suffix:
    • Title:

    • Telephone Number:

    • Email:
Fax Number:

    • Signature of Authorized Representative:								* Date Signed:



U.S. Department of Education
Supplemental Information for the SF-424 Application for Federal Assistance

    1. Project Director:
Prefix:	* First Name:	Middle Name:	* Last Name:	Suffix:

Project Director Level of Effort (percentage of time devoted to grant): Address:
        ◦ Street1:

Street2:

        ◦ City: County:

        ◦ State:
        ◦ Zip Code:
Country:


        ◦ Phone Number (give area code):	Fax Number (give area code):
        ◦ Email Address:	Alternate Email Address
 

    2. New Potential Grantee or Novice Applicant:

    a. Are you either a new potential grantee or novice applicant as defined in the program competition’s notice inviting applications (NIA)?
Yes	No

    b. If the program competition NIA is giving competitive preference points for a new potential grantee or novice applicant, how many points are you claiming for your application? (the NIA will indicate how many are available)


    3. Qualified Opportunity Zones:
If the NIA includes a Qualified Opportunity Zones (QOZ) Priority in which you propose to either provide services in QOZ(s) or are in a QOZ, provide the QOZ census tract number(s) below:


	 


    4. Human Subjects Research:

    a. Are any research activities involving human subjects planned at any time during the proposed Project Period?

Yes	No

    b. Are ALL the research activities proposed designated to be exempt from the regulations?

Yes	Provide Exemption(s) # (s):  1  2  3  4  5  6  7  8

No	Provide Assurance #(s), if available:

    c. If applicable, please attach your “Exempt Research” or “Nonexempt Research” narrative to this form
as indicated in the definitions page in the attached instructions.

	






DISCLOSURE OF LOBBYING ACTIVITIES

 
















































OMB Control No. 1894-0005 (Exp. 06/30/2023)
	
NOTICE TO ALL APPLICANTS

The purpose of this enclosure is to inform you about the following provision in the Department of Education's General Education Provisions Act (GEPA) that applies to applicants for new grant awards under Department programs.  This provision is Section 427 of GEPA, enacted as part of the Improving America's Schools Act of 1994 (Public Law (P.L.) 103-382).
To Whom Does This Provision Apply?

Section 427 of GEPA affects applicants for new grant awards under this program.  ALL APPLICANTS FOR NEW AWARDS MUST INCLUDE INFORMATION IN THEIR APPLICATIONS TO ADDRESS THIS NEW PROVISION IN ORDER TO RECEIVE FUNDING UNDER THIS PROGRAM.

(If this program is a State-formula grant program, a State needs to provide this description only for projects or activities that it carries out with funds reserved for State-level uses.  In addition, local school districts or other eligible applicants that apply to the State for funding need to provide this description in their applications to the State for funding.  The State would be responsible for ensuring that the school district or other local entity has submitted a sufficient section 427 statement as described below.)
What Does This Provision Require?

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.  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, you should determine whether these or other barriers may prevent your students, teachers, etc. from such access or participation in, the Federally-funded project or activity.  The description in your application of steps to be taken to overcome these barriers need not be lengthy; you may provide a clear and succinct description of how you plan to address those barriers that are applicable to your circumstances.  In addition, the information may be provided in a single narrative, or, if appropriate, may be discussed in connection with related topics in the application.

Section 427 is not intended to duplicate the requirements of civil rights statutes, but rather to ensure that, in designing their projects, applicants for Federal funds address equity concerns that may affect the ability of certain potential beneficiaries to fully participate in the project and to achieve to high standards.  Consistent with program requirements and its approved application, an applicant may use the Federal funds awarded to it to eliminate barriers it identifies.
What are Examples of How an Applicant Might Satisfy the Requirement of This Provision?

The following examples may help illustrate how an applicant may comply with Section 427.

    1) An applicant that proposes to carry out an adult literacy project serving, among others, adults with limited English proficiency, might describe in its application how it intends to distribute a brochure about the proposed project to such potential participants in their native language.

    2) An applicant that proposes to develop instructional materials for classroom use might describe how it will make the materials available on audio tape or in braille for students who are blind.

    3) An applicant that proposes to carry out a model science program for secondary students and is concerned that girls may be less likely than boys to enroll in the course, might indicate how it intends to conduct "outreach" efforts to girls, to encourage their enrollment.

    4) An applicant that proposes a project to increase school safety might describe the special efforts it will take to address concern of lesbian, gay, bisexual, and transgender students, and efforts to reach out to and involve the families of LGBT students

We recognize that many applicants may already be implementing effective steps to ensure equity of access and participation in their grant programs, and we appreciate your cooperation in responding to the requirements of this provision.

U.S. DEPARTMENT OF EDUCATION
BUDGET INFORMATION NON-CONSTRUCTION PROGRAMS
OMB Control Number:  1894-0008
Expiration Date:  09/30/2023
Name of Applicant Organization       


Applicants requesting funding for only one year should complete the column under "Project Year 1."  Applicants requesting funding for multi-year grants should complete all applicable columns.  Please read all instructions before completing form.
SECTION A - BUDGET SUMMARY U.S. DEPARTMENT OF EDUCATION FUNDS
Budget Categories
Project Year 1
(a)
Project Year 2
(b)
Project Year 3
(c)
Project Year 4
(d)
Project Year 5
(e)
Project Year 6
(f)
Project Year 7
(g)
Total
(h)
1. Personnel








2. Fringe Benefits








3. Travel








4. Equipment








5. Supplies








6. Contractual








7. Construction








8. Other








9. Total Direct Costs (lines 1-8)








10. Indirect Costs
*Enter Rate Applied:








11. Training Stipends








12. Total Costs (lines 9-11)








*Indirect Cost Information (To Be Completed by Your Business Office):
If you are requesting reimbursement for indirect costs on line 10, please answer the following questions:
    (1) Do you have an Indirect Cost Rate Agreement approved by the Federal government?   ____Yes   ____No. 
    (2) If yes, please provide the following information and provide a copy of your Indirect Cost Rate Agreement:
         Period Covered by the Indirect Cost Rate Agreement:  From: ___/___/______ To:  ___/___/______  (mm/dd/yyyy)
         Approving Federal agency:  ____ED     ____Other (please specify):  __________________________ The Indirect Cost Rate is   _________%
    (3)    If this is your first Federal grant, and you do not have an approved indirect cost rate agreement, are not a State, Local government or Indian Tribe, and are not funded under a training rate program or a restricted rate program, do you want to use the de minimis rate of 10% of MTDC? ____Yes  ____No.  If yes, you must comply with the requirements of 2 CFR § 200.414(f).
    (4) If you do not have an approved indirect cost rate agreement, do you want to use the temporary rate of 10% of budgeted salaries and wages?  ____Yes  ____No.  If  yes, you must submit a proposed indirect cost rate agreement within 90 days after the date your grant is awarded, as required by 34 CFR § 75.560.
    (5) For Restricted Rate Programs (check one) -- Are you using a restricted indirect cost rate that:___ Is included in your approved Indirect Cost Rate Agreement?  
         Or ___ Complies with 34 CFR 76.564(c)(2)? The Restricted Indirect Cost Rate is _________%
    (6) For Training Rate Programs (check one) -- Are you using a rate that: ____Is based on the training rate of 8 percent of MTDC (See EDGAR § 75.562(c)(4))?  Or ____Is included in your approved Indirect Cost Rate Agreement, because it is lower than the training rate of 8 percent of MTDC (See EDGAR § 75.562(c)(4)).
Name of Applicant Organization      


Applicants requesting funding for only one year should complete the column under "Project Year 1."  Applicants requesting funding for multi-year grants should complete all applicable columns.  Please read all instructions before completing form.
SECTION B - BUDGET SUMMARY
NON-FEDERAL FUNDS

Budget Categories
Project Year 1
(a)
Project Year 2
(b)
Project Year 3
(c)
Project Year 4
(d)
Project Year 5
(e)
Project Year 6
(f)
Project Year 7
(g)
Total
(h)









1. Personnel








2. Fringe Benefits








3. Travel








4. Equipment








5. Supplies








6. Contractual








7. Construction








8. Other








9. Total Direct Costs
(Lines 1-8)








10. Indirect Costs
*Enter Rate Applied:








11. Training Stipends








12. Total Costs
(Lines 9-11)








SECTION C – BUDGET NARRATIVE (see instructions)

Name of Applicant Organization      


Applicants requesting funding for only one year should complete the column under "Project Year 1."  Applicants requesting funding for multi-year grants should complete all applicable columns.  Please read all instructions before completing form.
IF APPLICABLE: SECTION D – LIMITATION ON ADMINISTRATIVE EXPENSES
    (1) List administrative cost cap (x%): _____
    (2) What does your administrative cost cap apply to? __ (a) indirect and direct costs or __ (b) only direct costs

Budget Categories
Project Year 1
(a)
Project Year 2
(b)
Project Year 3
(c)
Project Year 4
(d)
Project Year 5
(e)
Project Year 6
(f)
Project Year 7
(g)
Total
(h)









1. Personnel Administrative








2. Fringe Benefits Administrative








3. Travel Administrative








4. Contractual Administrative








5. Construction Administrative








6. Other Administrative








7. Total Direct Administrative Costs (lines 1-6)








8. Indirect Costs
     *Enter Rate Applied:








9. Total Administrative Costs








10. Total Percentage of Administrative Costs