PBI Program Profile

Predominantly Black Institutions Application

Att_PREDOMINANTLY BLACK INSTITUTIONS PROGRAM PROFILE 1.25.08

Predominantly Black Institutions Program Profile Sheet

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PREDOMINANTLY BLACK INSTITUTIONS PROGRAM PROFILE


INSTRUCTIONS: ALL applicants must complete this page. Applicants must copy and past this page into a separate document, or recreate the page as exactly as it appears. Then complete the page, save it to your computer and attach it to the “Other Attachments Form” as either a .doc, .rtf, or pdf document. DO NOT MODIFY…. The completed page must be attached to the “Other Attachments Form” in the application package in Grants.gov (as either a .doc, .rtf or. pdf document). DO NOT MODIFY OR AMEND THIS PAGE.

OPE ID #___________


1. INSTITUTION (Legal Name):


_____________________________________________________________________


2. Are you applying as a Branch Campus? _____YES _____NO


3. ADDRESS (Applicants must indicate the address where the project will be located):


Project Address: _____________________________________________________________________


City: _____________________________________State: ______Zip: _____________


4. PREDOMINANTLY BLACK INSTITUTIONS PROGRAM CERTIFICATION:


By checking this box (or placing an “X” beside it), the applicant certifies pursuant to the statutory requirements governing the Predominantly Black Institutions Program, authorized under CCRAA, that: The named institution of higher education, at the time of application, meets the definition of a predominantly Black institution as defined by the CCRAA of 2007.


Specifically:


Total Undergraduate Headcount Enrollment: ___________

Black American Undergraduate Headcount Enrollment: ___________


Percent of Black American Enrollment of Undergraduate Students: ___________


Authorized Representative

Name:

Date:

Telephone:



File Typeapplication/msword
File TitlePREDOMINANTLY BLACK INSTITUTIONS PROGRAM PROFILE
AuthorBernadette.Miles
Last Modified ByDoED User
File Modified2008-02-04
File Created2008-02-04

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