INSTRUCTIONS: ALL applicants must complete this page. Applicants must copy and paste 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: it has an enrollment of financially needy undergraduate students; and enrollment of undergraduate students at least 40% of whom are Black; and, has at least 1,000 undergraduate students of whom not less than 50% enrolled at the institution are low-income or first generation and registered in a BA or AA program leading to a degree.
Total Undergraduate Headcount Enrollment: _____________
Black American Undergraduate Headcount Enrollment: #______ _____%
Low-income or first generation: #______ _____%
Registered in a BA or AA program: #______ _____%
Authorized Representative
Name:
Date:
Telephone:
| File Type | application/msword |
| File Title | PREDOMINANTLY BLACK INSTITUTIONS PROGRAM PROFILE |
| Author | Bernadette.Miles |
| Last Modified By | DoED User |
| File Modified | 2008-02-21 |
| File Created | 2008-02-21 |