DLT Forms and Application Guide

Distance Learning &
Telemedicine Program
Grant Application Guide
Fiscal Year 2011

Rural Utilities Service
Rural Development
United States Department of Agriculture

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2011 DLT Grant Application Guide

Contents
Distance Learning and Telemedicine Grant Program
Section I.
A.
B.
C.
D.
E.
F.
Section II.
A.
B.
C.
D.
Section III.
A.
B.
C.
Section IV.

1

GENERAL INFORMATION…………………………………………….….2
Types of Financial Assistance
Fiscal Year 2011 Funding
Who’s Eligible?
Scoring Criteria
Contacts & the Web
Freedom of Information Act

2
2
3
3
5
5

APPLICATION SUBMISSION ….…………..……………………………...6
DLT Program Regulation and FY 2011 Application Guide
(Reminders & Process Changes for FY 2011)
FY 2011 Application Deadline
How to Submit a Paper Application
How to Submit an Electronic Application

6
8
9
9

APPLICATION PROCESS …………………………………………….…...11
Review Process
Score Appeal Process
Grant Awards

11
11
12

THE COMPLETE APPLICATION………………………………………...13

A.

Standard Form 424 and Attachments

14

B.

Legal Eligibility

19

C.

Executive Summary

22

D.

Project Information (Eligible & Ineligible Purposes)

23

D-1.

Telecommunications System Plan and Scope of Work

29

Categorizing Sites and End-users

29

Apportioning DLT Project Benefit

32

Telecommunications System Plan Details

34

Scope of Work

38

D-2.

Budget

38

D-3.

Financial Information and Sustainability

48

D-4.

Statement of Experience

48

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2011 DLT Grant Application Guide

E.

F.

G.
H.

Objective Scoring Supporting Documentation

49

E-1. Rurality

49

E-2. National School Lunch Program (NSLP)

67

E-3. Leveraging (Matching Funds)

71

E-4. Empowerment Zones
Subjective Scoring
F-1. Additional NSLP
F-2. Community Needs and Project Benefits
F-3. Innovativeness of the Project
F-4. Cost-Effectiveness of the Project
Contact with USDA State Director – Rural Development
Certifications

77
78
80
80
82
84
84
85

Section V.

Putting It All Together……………………………………………………….86

Appendix

Review of Process Changes from FYs 2006 & 2007

ii

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2011 DLT Grant Application Guide

Distance Learning and Telemedicine Grant Program
Administered under the Rural Utilities Service – a Rural Development Agency of the
United States Department of Agriculture
Advanced telecommunications services play a vital role in the economic development, education
and health care of rural Americans. The Distance Learning and Telemedicine (DLT) Program is
specifically designed to meet the educational and health care needs of rural America through the
use of advanced telecommunications technologies. With DLT grants, loans, and loan-grant
combinations, we have helped rural communities enjoy enhanced educational opportunities,
improved health care services and greater economic development.
Our partnership with rural America is long-standing. For 60 years, the Telecommunications
Program has been at the forefront of providing the infrastructure financing that brought advanced
telecommunications services to the most rural areas of our country. Today, the
Telecommunications Program of the Rural Utilities Service continues as an essential source of
financing and technical assistance for rural telecommunication systems. The DLT Grant
Program strengthens that partnership and commitment by continuing to improve the quality of
life for rural citizens.
Through its telecommunications infrastructure loan programs and DLT Program, we have helped
build community partnerships that provide both the infrastructure needed to reach the
schoolhouse or clinic door and the equipment required inside that door.
Your organization is to be commended for its interest in providing rural residents - students,
teachers, parents, patients and physicians - with innovative and affordable educational and health
care opportunities which were once available only in more urban areas. By submitting an
application for financing under the DLT Program, you take a significant step toward improving
the quality of life in rural America.
In this guide, you will find information on eligibility requirements; funding purposes and types
of financial assistance; the how, when, and where to submit an application; and tips that will be
useful in preparing your application.

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2011 DLT Grant Application Guide

Section I - General Information
This Application Guide will help you apply for a grant under the DLT Program. Where
appropriate, the Guide includes suggestions and samples. Please note that the suggestions and
samples are not a formula for a successful application. We urge you to use your unique
understanding of your community and your project to prepare a compelling case for grant
financing.
We endeavor to make this Application Guide a complete source of information on how to
prepare a successful application and have designed it for the first-time applicant with no previous
experience applying for grants. We hope that you will find it helpful.

A. Types of Financial Assistance
The DLT Program is legislatively authorized to provide three kinds of financial assistance.
1. 100% Grant
2. Combination Loan-Grant (no current Budget Authority)
3. 100% Loan (no current Budget Authority)
The eligible purposes for 100% grants are the most restrictive. More purposes are eligible under
the combination loan-grant and even more are eligible for a 100% loan. This guide covers the
application requirements for a 100% grant.
If your project includes purposes not eligible under the 100% grant program such as projects for
Electronic Medical Records, please consider one of those financing options should funding be
provided for them. However, at the time this document was prepared, the Agency has no Budget
Authority to make Loans or Combos. Should that change in a future appropriations process, we
will publish a Notice of Funds Availability in the Federal Register.

B. Fiscal Year 2011 Grant Funding
As of the date this document was prepared, the DLT Grant Program does not have an annual
appropriation so the amount available for Grants is not known. Last year, the Program received
an appropriation of approximately $30 million. With respect to the size of awards, the maximum
is $500,000 and the minimum is $50,000. There has been no budget authorization for the
Combination Loan/Grant or Loan Programs for the last several years. Should fund be
appropriated, Program levels would be announced at a later date in the Federal Register.

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C. Who’s Eligible?
To be eligible for a grant, your organization must:
1. Currently deliver or propose to deliver distance learning or telemedicine services for the term
of the grant. To receive a grant, the purposes must meet the grant definition of distance
learning and/or telemedicine. The DLT program is focused on sustainability. Planning
studies, research projects, and short-term demonstration projects of less than life of the award
(three years) will not be considered.
2. Be legally organized as an incorporated organization or partnership; an Indian tribe or tribal
organization; a state or local unit of government; a consortium; or other legal entity,
including a private corporation organized on a for profit or not-for profit basis with the legal
capacity to contract with the United States Government. Specific legal definitions and
citations can be found in 7 CFR 1703.103(a)(1) & 1703.125(k).
Note : Many applicants for DLT Grants are informal consortia (groups of legal entities
such as school districts that are working together specifically for the purpose of the
grant project but that do not have a separate existence as a consortium). For additional
guidance about applying as a consortium, please turn to Legal Eligibility under Section
IV-B.
3. Operate a rural community facility or deliver distance learning or telemedicine services to
entities that operate a rural community facility or to residents of rural areas at rates calculated
to ensure that the benefit of the financial assistance passes through to such entities or to
residents of rural areas.
Note: Electric or telecommunications borrowers financed through the Utilities Programs of
Rural Development are not eligible for grants, but are eligible for loans. See the Loan and
Combination Loan-Grant Application Guide for more information.

D. Scoring Criteria
The DLT Grant Program is competitive. Applications are scored in objective and subjective
categories. Objective criteria are generally straightforward indicators. Subjective criteria are
comparative in the sense that the score of one application is based on comparison to other
applications received that year.
For each category, these tables display the shorthand name in bold, a simple summary, and the
maximum points available. Although the eight categories appear to add to a maximum score of
230, the maximum score that can actually be earned is 220 points. This is because the Additional
NSLP points are available only to applicants who score 15 or fewer of the 35 points possible
under the NSLP category. More detailed descriptions of the scoring categories can be found in
Section IV of this Application Guide.

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Objective Criteria
Rural Area (Rurality)

This criterion measures rural benefit. To be eligible for a
grant, the applicant must earn a minimum score of 20 points
in this category based on Census data. (up to 45 Points)

Economic Need (NSLP)

This criterion measures the general economic need of the area
through the use of statistics from the National School Lunch
Program (NSLP). (up to 35 Points)

Matching Funds (Leveraging)

The DLT program requires a minimum match of 15%.
Higher matches receive points. There are special matching
provisions for American Samoa, Guam, Virgin Islands, and
the Northern Mariana Islands. (up to 35 Points)

Empowerment Zones (EZ)

This criterion awards points to projects located in a USDA
Empowerment Zones. (up to 10 Points)

Subjective Criteria
Additional NSLP

An applicant with an NSLP eligibility below 50% may
request additional points based on a well-documented
demonstration that the NSLP percentage is not an accurate
indicator of the economic need of the area. (up to 10 Points)

Need for Services and Project
Benefits (Needs & Benefits)

This criterion measures the specific needs of the community
and how the proposed project will meet those needs, not the
general need captured by the NSLP score. (up to 45 Points)

Innovativeness

This criterion assesses how the objectives of the proposed
project are met in new and creative ways. (up to 15 Points)

Cost Effectiveness

This criterion evaluates the efficiency with which the
proposed project delivers educational and/or medical benefits
to beneficiaries. (up to 35 Points)

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2011 DLT Grant Application Guide

E. Contacts & the Web
The DLT Program staff is available to answer questions about the application process and
program requirements. In particular, and as described more thoroughly elsewhere in this Guide,
we remind applicants that applications are evaluated for eligibility and score based on
information submitted by the application deadline. We will not solicit or consider information
submitted after the application deadline. If you have questions, the time to contact us with those
questions is before you submit the application.
Contact us at:
Phone: 202-720-0413
Fax: 202-720-1051
Email: dltinfo@wdc.usda.gov
We post the latest DLT developments including the FY 2011 Application Guide : (Narrative,
Toolkit, & Regulation) and Notice of Funding Availability on the DLT Resources Web page:
www.rurdev.usda.gov/UTP_DLTResources.html

F. Freedom of Information Act
Should your organization win an award, your application must be made available to others if
requested under provisions of the Freedom of Information Act (FOIA). Under FOIA, some
sensitive information is protected from release, but the balance is not. Costs to assemble and
duplicate the material are charged to the entity that requests the information. If you provide any
information in your application that you feel should be protected, please identify it, and provide
justification for why it should be withheld. For more information about FOIA see:
www.da.usda.gov/foia.htm
It is our experience that the common motivation for obtaining a DLT application under FOIA is
so that it can be used as a template. We do not believe that this is a productive approach to
crafting a successful DLT application. Disregarding the cost of obtaining another applicant’s
grant under FOIA, which can be considerable, most of that application would be irrelevant as
guidance to a prospective applicant. And while it might seem useful to see another’s responses
in the subjective scoring categories, the best scores in those categories are awarded for responses
specific to the applicant’s project.
Good applications do not spring from a template. As noted above, we endeavor to make this
Application Guide a complete source of information on how to prepare a successful application
and have designed it for the first-time applicant with no previous experience applying for grants.
As an applicant, remember that no one knows your project and special circumstances as well as
you. As a consequence, no one can do a better job of crafting an application than you.

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2011 DLT Grant Application Guide

Section II - Application Submission

A. DLT Program Regulation and FY 2011 Application Guide
The implementing regulation for the DLT Program is 7 CFR 1703, Subparts D through G (Part
1703) as supplemented by the FY 2011 Notice of Solicitation of Applications (NOSA) and as
elaborated upon in this Application Guide. The FY 2011 Application Guide is designed to be an
easy-to-use version of Part 1703 and the NOSA.

Reminders and Process Changes for FY 2011
Application Preparation – In the Executive Summary (TAB C), we ask that you identify the
grant writer, i.e., the person or organization responsible for preparing the application and the
relationship of that writer to the applicant. For example, the writer may be a staff member of the
applicant organization, a professional grant writer, or an equipment vendor. With respect to
equipment vendors, we hear of applicants that make arrangements with vendors to prepare their
application with the understanding that should the applicant win an award, the awardee will
obtain its equipment from that vendor. Please be aware that we do not recognize and will not
enforce such a quid pro quo. We expect awardees to purchase equipment that best meets the
needs of their project at the best possible price. Vendors that choose to assist applicants with
their application should understand that they do so at their own risk.
Contact Information - Certain aspects of the DLT competition may require you to respond to us
by a deadline based on the date of our correspondence which we send to you by fax. We want to
make it absolutely clear that the fax will be sent to the contact person shown in block f of the
SF-424, Application for Federal Assistance, unless that block does not contain a fax number. In
that case, the fax will be sent to the fax number of the person who signs the SF-424 as shown in
block 21. If no fax number is provided, or if the contact fax number is changed without our
being informed, correspondence will be sent by regular mail.
DUNS and Central Contractor Registration – Applicants have been required for several years
to provide a DUNS number. Please make certain they are correct. Applicants are now required
to register at the Central Contractor Registration site – www.ccr.gov.
Exact Site Location – It is important that we be able to locate your sites precisely. In cases
where the applicant needs to identify a site by latitude and longitude, we have added an example
of how to obtain those coordinates. See page 17.
Previous Awards – Discuss any DLT awards received in the previous two years (2009 & 2010
competitions) by the applicant or other participants in the project. See item 6 under
―Telecommunications System Plan Details.‖

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2011 DLT Grant Application Guide

Eligible Purposes – Instructional Programming - There are three categories of eligible
purposes under the DLT Grant Program and those purposes are described in detail elsewhere in
this Guide. Under §1703.121 it is stated that ―(g)rants shall be expended only for the costs
associated with the initial capital assets associated with the project. In brief, the eligible
purposes are (1) equipment, (2) instructional programming, and (3) technical assistance and
instruction for using eligible equipment.
With respect to instructional programming, to be eligible, such programming must be an initial
capital asset such as the cost associated with the first-time acquisition of reusable educational
software related to the current project. Renewals of instructional programming will not be
credited as an eligible match. Also, tuition, per-course charges, and fees for events such as field
trips are expenses, not capital assets. As a consequence they are not eligible for grant funding
and can not be credited as match.
Focus on Rural Areas - Applicants are reminded that the intent of the DLT Program as
envisioned in the legislation establishing the Program and regulation which implements the
Program (7 CFR 1703) is to benefit rural areas (20,000 or less). It is important to note that the
definition of ―end-user‖ in the regulation envisioned only rural facilities such as rural
elementary, secondary, and other educational institutions; rural hospitals, primary care centers,
or other rural community facilities. We encourage applicants to bear this in mind and limit their
projects to rural end-users. While we recognize that applicants may desire to include urban
(>20,000) end-users in their project, the Agency reserves the right to evaluate the benefit that
flows to urban areas and adjust grant and match funds budgeted for the benefit of urban endusers when the urban benefit is either not necessary to serve rural areas or when the urban benefit
is more than incidental to the benefit to rural end-users.
Internet Based Systems – From time to time, we receive applications from educational
institutions that wish to provide a curriculum via the Internet. Frequently, the applicant will
describe its ―target‖ audience as students in rural areas. However, the offering is usually
available over the Internet with beneficiaries that can be anywhere including urban areas. Such
projects cannot be accurately scored for rural benefit (Rurality). While the intent may be to
serve rural areas, if the area cannot be accurately scored because it is geographically undefined,
we cannot consider it for funding. See Section IV, E-1 for more detail about measuring rural
benefit and calculating your Rurality score.
Applications from a Consortium – Many of the applications we receive come from consortia.
On occasion, the applicant is an existing established consortium with the legal ability to contract
with the Federal Government. Such an organization can apply in the name of the formal
consortium.
Far more common is an application from a group of legal entities that have joined solely for the
purpose of a DLT project without creating a formal structure. When such an ―informal
consortium‖ wins an award, it leads to complications and delays in executing a grant agreement.
An informal consortium that has no legal existence is not eligible to receive an award. To
reduce complications during the award process, we have provided additional guidance
about legal eligibility and considerations when applying as a consortium. You will find this
guidance under Section IV-B, Legal Eligibility.

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2011 DLT Grant Application Guide

NSLP – The instructions provided in previous years with respect to rounding did not precisely
conform to the regulation. NSLP percentages should not be rounded. See Section E-2 for
details.
In-Kind Matching – Last year we saw an increase of in-kind matches that could not be credited.
Remember that the purposes for match and grant are identical and that to be credited an in-kind
match must be integral to and necessary for the DLT project, not simply a technology purchase
made in the same timeframe. See Section E-3 including the ―special note‖ for details about inkind matching.
EZ Designations – There have been changes with respect to USDA designations of
Empowerment Zone, Enterprise Community, and Champion Community. See Section E-4 for
details.
Other Changes - Each year, we adjust and amplify the Application Guide based on experience
gained the previous year. This year is no different. For example, many applications come from
informal consortia. In such cases, each member completes a set of Certifications under Tab H.
Because this can create a large amount of paper, applicants may choose to supply a single set of
certifications with the original copy of the application. In most respects, however, this Guide is
quite similar to last year’s and includes no major process changes. Nevertheless, we encourage
all applicants, even those who applied last year, to thoroughly review this year’s edition because
there is additional useful guidance and information throughout. For those who may have applied
several years ago and have found the guide changed from what they remember, the descriptions
and justifications for the larger process changes as described in the FY 2006 and 2007
Application Guides can be found in an appendix at the back of this Guide.

B. FY 2011 Application Deadline – April 25, 2011
Applications are evaluated for eligibility and scored on information submitted by the application
deadline. RUS will not solicit or consider eligibility and scoring information submitted after the
deadline. All applications must either be delivered into our hands or carry third-party proof of
shipping (or electronic submission, if applicable) by the application deadline to be eligible for
funding consideration under the FY 2011 DLT program. Applications will not be accepted by
fax or e-mail. Late applications will be returned without being considered for funding.
No Time Extensions – The Agency does not grant extensions to the grant application deadline
under any circumstances.

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2011 DLT Grant Application Guide

C. How to Submit a Paper Application
Paper/Electronic Hybrid – We recognize that many applicants transcribe our forms
into electronic form. This year we are providing the DLT Toolkit in Word as well as
PDF. The Word version allows text to be entered. In addition, we are providing the
Budget Worksheets in Excel. If you have prepared your Budget in Excel, we encourage
you to copy electronic versions of your Worksheets onto a CD or DVD and attach them
to your paper application.
Applications are to be presented in the format described in this Guide. Paper applications
must either be delivered and in our hands by the application deadline or show proof-of-shipping
no later than the application deadline. The proof-of-shipping must be from a third party such
as the Postal Service or a commercial carrier. Evidence of shipping not under direct control of
such a third party, such as a printed label from a postage meter, does not constitute proof-ofshipping. The following proofs are acceptable:
A legibly dated U.S. Postal Service postmark
A legible mail receipt with the date of mailing stamped by the USPS
A dated shipping label, invoice, or receipt from a commercial carrier

Ship at least one copy with original signatures and two additional copies of
your application to:
Director, ASD
Telecommunications Program, STOP 1550, Room 2844
1400 Independence Ave., SW
Washington, D.C. 20250-1550
Note: Packages arriving at USDA via ordinary first-class mail (USPS) are irradiated, which can
damage the contents. We encourage you to consider the impact of this procedure in selecting
your shipping method.

D. How to Submit an Electronic Application
In past years, applicants attempting to use the Grants.gov website near the application deadline
have experienced technical difficulties and delays. In conversations with these applicants, it has
become clear that they believe that Rural Development prefers and gives preference to electronic
applications. We want to assure applicants that our providing an online application method is
intended as a convenience for applicants. Paper and electronic applications receive equal
consideration and you should use the method you prefer.

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2011 DLT Grant Application Guide

Paper/Electronic Hybrid – We recognize that many applicants are attracted to the online application process because they have transcribed our forms into electronic form
and wish to submit them that way. This year we are providing the DLT Toolkit in Word
as well as PDF. The Word version allows text to be entered. In addition, we are
providing the Budget Worksheets in Excel. If you have prepared your Budget in Excel,
and you wish to file a paper application, we encourage you to copy electronic versions
of your Worksheets onto a CD or DVD and attach them to a paper application as
described in the previous section.
Applications are to be presented in the format described in this Guide. You should be aware
that the grants.gov site breaks your application into multiple files, which we must print and
assemble. We ask that you identify each page of an electronic submission with a Tab identifier
and page number, as if you were submitting a paper application, so that it is absolutely clear
where you intended each page to go in the assembled application.
If you plan to use electronic submission close to the application deadline, we urge you to have an
alternative plan for physical shipment of your application in the event you experience technical
difficulties with the Grants.gov site. Delays caused by Grants.gov in accepting your application
do not constitute a basis for submitting your application after the deadline.
We accept electronic applications submitted by the deadline though we may request original
signatures on paper later. Use the Federal government’s e-grants web site (Grants.gov):
www.grants.gov
Allow yourself plenty of time. If you want to submit an application on-line, we strongly
encourage you to obtain all the necessary sign-ups, credentials and authorizations well in
advance of the application deadline. You will need a Central Contractor Registry (CCR)
registration before you can submit electronically. In addition, Grants.gov requires some onetime credentialing and online authentication procedures. These procedures may take several
business days to complete.
Please follow the instructions at Grants.gov. If you experience a technical problem retrieving or
submitting an electronic application, make the Grants.gov customer support resources your first
stop (click the ―Customer Support‖ tab on any page of Grants.gov to get started). Grants.gov is
operated by a Federal Agency that is not part of the USDA. The DLT staff has no control of
Grants.gov. Neither does it have specific knowledge of how the process works or ability to assist
with technical problems.

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Section III - Application Process

A. Review Process
We review each on-time application for completeness to determine whether it includes all items
required by the regulation. If the application is complete, the applicant will be so informed.
Applications are evaluated for eligibility and scored on information submitted by the
application deadline. Eligibility and scoring information submitted after the application
deadline will not be solicited or considered. Applications that do not meet the minimum set
of requirements as specified in the relevant rules (7 CFR 1703 and the 2011 Notice of
Solicitation of Applications) and as elaborated upon throughout this Guide will be returned
as ineligible for funding consideration along with a letter explaining the determination.
In cases where we have minor questions about an item, we may request clarification. Also,
missing information not necessary for determining eligibility or scoring, but necessary for the
award of a grant will be requested. In such cases, the applicant has fifteen calendar days to
deliver a response to this request. If that response is satisfactory to the Agency, the applicant
will be informed that its application is complete. If not, the application will be returned as
ineligible for funding consideration.

B. Score Appeal Process
If your application is eligible for funding consideration, and upon completion of the scoring
process, the Agency will notify you in writing of your preliminary score (Applications that are
not eligible for funding consideration are not scored). We will also include an estimate of the
minimum score necessary to receive a grant. We stress that this funding threshold score is an
estimate that can go up or down depending on several factors including appeals (as described
below) and budgetary factors that cannot be known with certainty at the time the estimated score
is reported to you. If your preliminary score is below the threshold, it does not mean that you
have been denied a grant. Conversely, if your score is above the threshold, it does not ensure
that you will receive a grant.
As the applicant, you have the right to appeal your preliminary score. For an appeal to receive
consideration, you must deliver your written appeal into our hands within ten calendar days
of the date of our correspondence informing you of your preliminary score. Scoring appeals
from anyone but the applicant cannot be considered. Also, we cannot consider information that
was not part of the application as submitted by the deadline so do not submit such additional
information in support of your appeal.

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Appeals of Objective Scores -To be successful, the applicant must demonstrate that the Agency
made a scoring error based on the application as submitted by the deadline. In general, this
means that the appeal of an objective score is more likely to result in a scoring change. This is
because objective scoring is based on objective data. If the applicant can demonstrate an error
on our part in evaluating the objective data in the application, the appeal will be successful.
Appeals of Subjective Scores - An applicant is free to appeal a subjective score, but it should be
aware that such an appeal is much less likely to be successful. As the name suggests, subjective
scores are based on the subjective reaction of our scoring teams to the supporting arguments
made in the application. This means that if a project were scored by two teams, it would likely
receive different scores because the process is subjective. That does not mean that one score is
correct and the other incorrect. Just as in the review of a football play by the replay officials, it
takes indisputable evidence to alter a scoring judgment made by the subjective reviewers. Not
only are these scores subjective, they are relative, in the sense that each application is scored in
comparison to other applications in the competition that year. This means that scores received in
prior years for similar projects are not relevant. Without knowledge of how the other applicants
in the current competition made their case and how the supporting documentation in your
application compares to that submitted by others, it is difficult for an applicant to demonstrate
scoring error on our part.

C. Grant Awards
Following the appeals process, we rank applications by their final scores. Applications are
selected for funding based on scores, availability of funds, and 7 CFR 1703.127.
Regardless of the number of points your application receives, the Administrator may take any of
the following actions:
1. Limit the number of applications selected for projects located in any one State during a fiscal
year. (This authority allows the Administrator to limit awards to any one state. It does not
allow the Administrator to make awards in other states regardless of score.)
2. Limit the number of selected applications for a particular project.
3. Select an application receiving fewer points than another application if there are insufficient
funds during a particular funding period to select the higher scoring application. If the
Administrator makes this kind of selection and it affects your application, we will provide
you an opportunity to reduce the amount of your grant request to the amount of funds
available.
Grant Agreement and Term – DLT grants have a term of 3 years and cannot be extended. A link
to the standard form of DLT grant agreement can be found on the DLT Resources page at:
www.rurdev.usda.gov/UTP_DLTResources.html

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Section IV - The Complete Application
Tips:
Before you begin to work on your application, read the entire Application
Guide including the Toolkit so that you have an overall sense of what is
expected.
An application that does not include each required item listed in this
section cannot be evaluated and will be returned as ineligible for funding
consideration. An application that does not include required scoring
information will be scored as is.
Certain aspects of this competition may require you to respond to us by a
deadline based on the date of our correspondence. Response deadlines are
not extendable under any circumstances. Please make absolutely certain that
you provide complete and accurate contact information in block f of the
SF-424, Application for Federal Assistance, so that we can contact you
promptly by fax rather than by conventional mail. Also, should any of
your contact information change after you submit your application, such as
your address or contact person, please inform us of the change.
It is important that the person who signs the Standard Form 424, Application
for Federal Assistance, documents his or her authority to do so. For example,
the Director of Information Systems at a school may have the authority to
obligate the school system, but in most cases, we have no means of confirming
this authority, or even of determining if the title shown on the SF-424 is
correct. Proper documentation is described in the instructions for Block 21,
which you will find in the Toolkit.
Use the 2011 Grant Application Guide Toolkit (Toolkit). It contains all the
forms, worksheets, and sample certifications that you will need to assemble
your application. Do not ignore guidance on the worksheets. It is there to help
ensure that you provide all the required information. Remember that with
respect to information necessary for determining eligibility and scoring, we
will not solicit or consider any such information that is submitted after the
application deadline. In addition to being included with the printed version of
the Application Guide, you can find the Toolkit at the DLT Web site.
www.rurdev.usda.gov/UTP_DLTResources.html
When you prepare your application, try to imagine that you are the Agency
reviewer responsible for making certain that the competition is fair and that
the federal funds designated for this program accomplish the goals of the
program. In every section, provide the level of detail and support that
would satisfy you if you were that reviewer. For example, reviewers are
unlikely to have first-hand knowledge regarding your specific locale or
circumstances so always provide source documentation to substantiate the
information in your application.

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Remember that scoring of the application is based in large part on who
benefits. Do not, for example, try to make your project appear to have more
rural impact either by excluding urban end-users that will benefit or by
including rural sites at which the project will have a minimal impact. Pay
careful attention to the sections in the application guide on apportioning
benefit.
Avoid upholstering your application with generic information concerning the
value of distance learning or telemedicine (such as magazine articles and web
page printouts unless they are specific to your area or project). We are well
aware of how these technological solutions can benefit rural areas.
Concentrate instead on the specifics of your project.
Remember that only rural areas qualify for this program and other applicants
will share the general characteristics of rural areas with you. You are not trying
to distinguish yourself from the cities and the suburbs. Concentrate instead on
the specifics of your rural area.
To be considered, information must be included under the proper Tab of
your application (as described below in Putting It All Together). Place all
of the information supporting a scoring category together in the section of the
application that responds to that category. Applications are to be presented
in the format described in this Guide. Submit your application package in a
properly tabbed three-ring binder. If you submit electronically, place the Tab
identifier and page number on each page of the application, as if it were a
physical application, so that we can assemble your application the way you
intended.

A. Standard Form 424 and Attachments
SF-424
DUNS and Central Contractor Registration – Please make certain your DUNS number is
correct. Applicants are now also required to register at the Federal Central Contractor
Registration (CCR) site – www.ccr.gov.
The SF-424, (Standard Form 424, Application for Federal Assistance is required to apply for
DLT grants. We use the version of the SF-424 prescribed by the Office of Management and
Budget Circular A-102. It carries a revision date of October 2005. We have reproduced the
form and included a copy suitably adapted to paper applications in the DLT Toolkit. We
combined the general instructions provided by OMB along with specific Agency instructions
into one set, striking through the OMB instructions that do not apply to the DLT Program. These
instructions follow the SF-424 in the Toolkit.

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Place the completed SF-424 under Tab A of your application, along with the Site Worksheet and
voluntary survey described below. The worksheet and survey are also included in the Toolkit.
Important Note – The legal name of the applicant (SF 424, Block 8) must be consistent with the
information provided under Tab B, Legal Eligibility. In particular, please note the additional
guidance provided for consortia (a group of legal entities that have joined together for the
purpose of a DLT project) in Section IV-B of this Application Guide.

Attachments to the SF-424
There are two attachments to the SF-424. One is a Site Worksheet (required) and the other is a
Survey on Ensuring Equal Opportunity for Applicants (optional). With regard to some of the
information requested on the Site Worksheets, please note that the Census web site has a wealth
of data beyond that described under E-1, Rurality, in Section IV of this guide. For example, the
same mapping tool we instruct you to use to show Census Population Data can display school
and congressional districts among many other things.
Site Worksheets - Complete identification of project sites is central to our ability to evaluate and
score your project. The space provided for this information on the SF-424 is insufficient for DLT
projects which by their nature generally involve multiple sites. We have created two Site
Worksheets to provide extra space, one for traditional fixed-site projects (such as for schools or
hospitals), the other for non-fixed sites, (such as a visiting nurse project).
You will attach the Site Worksheet appropriate to your type of project. The worksheets have
been designed not only to provide additional space to respond to the information requested in
Blocks 14, 15, & 16 of the SF-424, but also to link the project as described there directly and
specifically to the project as described throughout the balance of the application package.
With regard to the application process, there is no administratively practical way to score a
project that combines fixed, mobile, and non-fixed sites. As a consequence, we strongly
recommend that applications are for one or the other. If you have such a situation, it is best to
submit two applications. Otherwise, we will score each aspect separately and assign the lower
score to the entire project.
Fixed Site Worksheet
If your project operates at fixed sites, you will use the Fixed Site Worksheet that is provided in
the Toolkit. Complete that Worksheet and place it directly behind the SF-424 under Tab A of
your application. Include every site involved with your project (e.g., hub, hub/end-user or enduser) regardless of whether grant or match funds will be expended at that site or whether the sites
are included in your estimated scores. Applications that do not provide all of the site
information requested on the Site Worksheet, and which do not use the set of sites described
on that worksheet consistently throughout the application, cannot be evaluated or scored
and, as a consequence, will be returned to the applicant as ineligible for funding
consideration.

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For each site (hub, hub/end-user, or end-user), show:
The complete and formal name of the site. If you wish to use an abbreviation, show that
abbreviation and use it consistently throughout the balance of the application.
Positive Identification of the Site Location. As the applicant, you know where your sites
are located. For us to verify your Rurality score, you must provide us with unambiguous
evidence of that location. In some cases, the Census mapping tool will locate a site based
on its street address. Data from the Census’ Fact Finder website is required to document
your estimated Rurality score. See ―E-1 Rurality‖ in Section IV of this Application Guide
for more detail about the Fact Finder site and about completing the Rurality Worksheet.
factfinder.census.gov/home/saff/main.html?_lang=en
However, the Census mapping software does not provide a positive location in the way that
other sites do, say, by placing a star at the address. Also, the Census site sometimes does
not properly center the map on the address. That is why we ask you to place a copy of the
census map in your application with a pen and ink entry of the site’s exact location. When
there is any doubt, consider supplementing the Census Map with one from Mapquest or
Google Maps. Other maps from local governments can sometimes be useful supplements
to the Census Map for positively identifying a site location.
However, none of these resources are completely accurate or 100% current. For
example, a new school may show up on the aerial view from Mapquest as a vacant
field. If you cannot correctly, positively, and unambiguously identify a site location
with one of these resources by address, provide us the latitude and longitude of the
site location and explain any ambiguities. Latitude and longitude can be
determined from GPS devices and mapping software as well as many publicly
available sources including, for example, websites hosted by Maquest and
Microsoft. A summary of these resources is available at a Northern Arizona
University website:
http://jan.ucc.nau.edu/~cvm/latlon_find_location.html
Remember, we must know the exact location of every site. If the only address you provide
is a PO Box, Star Route, Rural Route, or other address not locatable on a map, you have
not provided a verifiable site location.

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Finding Your Latitiude and Longitude Example- Here is an example of determining your
coordinates using Google Maps. Find your location on the map by zooming. We recommend
using the satellite view that shows the structure such as a school or medical clinic. If the site does
not appear in the view because it was constructed recently, explain the circumstances. In this
example, we have used Dallas Cowboys Stadium in Arlington, Texas. Place the cursor over the
center of the stadium and right click. As shown below, a menu appears. Left click on ―What’s
here?‖

As shown below, an arrow will be added to the map and the latitude and longitude (32.74776
North, 97.092748 West) of that point will appear in the search box.

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The applicant’s designation of the type of site, i.e., a pure hub, a combination hub/end-user,
or a pure end-user. The distinction between a hub and a hub/end-user is important because
pure hubs are not included in the Rurality, NSLP, or EZ/EC calculations. As a
consequence, their inclusion or exclusion can have a significant effect on the applicant’s
score. See D-1, Telecommunications System Plan & Scope of Work, in Section IV of
this Application Guide for details on how to categorize sites in your application.
Remember that we start our review of an application with the presumption that most hubs
are actually hub/end-users. To designate a site as a pure hub, the applicant must provide a
convincing demonstration that no benefits flow to the site or to users at that site. The
Agency will review the evidence provided by the applicant to determine whether the site is
a pure hub or a combination hub/end-user. If the latter, we will include that site in the
appropriate scoring categories. For this reason, we recommend that you provide population
and NSLP data for every site including sites that you believe are pure Hubs so that we can
correct these scores if necessary.
The County, School District, and Congressional District in which the site is located.
Non-Fixed-Site Worksheet
If your project is for non-fixed sites like the service territory of a visiting nurse association, use
the Non-Fixed Site Worksheet. Complete that Worksheet and place it directly behind the SF-424
under Tab A of your application. Non-fixed site projects are evaluated over the entire official
service area. To be eligible for grant funding, a non-fixed site project must have an officially
defined service territory that can be unambiguously represented on a map. Applications that do
not provide all of the service territory information requested on the Site Worksheet, and
which do not show a consistent service territory throughout the application cannot be
evaluated or scored and, as a consequence, will be returned to the applicant as ineligible for
funding consideration.
For the service area of the non-fixed site project:
Provide a succinct, but thorough, narrative description of the territory in the space
provided. Attach a map showing the official, defined boundary as described, for
example, in the organization’s charter. (If your organization does not have a defined
boundary, we cannot evaluate the Rurality score, which makes it impossible to determine
eligibility.) In the past, applicants have not always provided sufficient information for us
to evaluate their project. For example, some applicants provided hand drawn maps or
vague word descriptions such as ―most of County A and part of County B.‖ Just as with
a physical site application, we must be able to precisely determine your service territory
in order to verify your score. To do that, we need a precise and complete identification of
your service territory.
Remember that this must be the official service territory to which your service offering is
practically limited as demonstrated by public information such as a description in your
organizing documents. For example, if your service is available worldwide on the
Internet, you can not say that your ―target‖ audience is limited to rural areas. Or if you
serve all of Lakeview County as chartered by the County, and your website says you
serve Lakeview County, the map of your service territory should reflect that you serve
the entire County.
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If the service is operated out of one service center, a hospital or ambulance garage, show
the complete street address of this site. (The address must be one which can be verified
as previously described above. See the bullet ―Positive Identification of the Site
Location‖ above under the heading ―Fixed Site Worksheet‖ for information on providing
this address.) If it is operated out of several centers, show the precise address of each
such site and describe in the narrative whether the service territory is served jointly or is
divided into specific autonomous regional operations. If the latter, show the service
territory boundaries of each autonomous region.
Show each County, School District, and Congressional District in the service territory that
will be served by the grant project, whether in whole or in part.
Not-For-Profit Survey - The Federal government is committed to ensuring that all qualified
applicants, small or large, non-religious or faith-based, have an equal opportunity to compete for
Federal funding. In order for us to better understand the population of applicants for Federal
Funds, we are asking not-for-profit private organizations (excluding public universities) to fill
out a survey. You will find a copy of the Survey Form in the Toolkit. Place the completed form
in a sealed enveloped behind the SF-424 and the appropriate Site Worksheet under Tab A of your
application. Information provided on the survey will not be considered in any way in making
funding decisions and will not be included in the Federal grants database. While your help in
this data collection process is greatly appreciated, completion of the survey is voluntary.

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B. Legal Eligibility - Legal Existence - Authority to Contract

Legal Eligiblity Criteria
You must provide evidence with respect to your legal eligibility, legal existence, and legal
authority to contract with The United States Government (See 7 CFR 1703):
1. Legal Eligibility: An applicant must be legally organized as an incorporated organization or
partnership, an Indian tribe or tribal organization, as defined in 25 U.S.C. 450b (b) and (c), a
state or local unit of government, a consortium, or other legal entity, including a private
corporation organized on a for-profit or not-for-profit basis. Evidence of tax status from the
Internal Revenue Service or a state department of taxation is not evidence of legal
eligibility.
2. Legal Existence: You must provide us with acceptable evidence of your legal eligibility.
Such evidence includes a certification as to legal existence from the Secretary of State in the
applicant’s state of incorporation, a certified copy of the applicant’s Articles of Incorporation,
or a copy of the state or local statute establishing an applicant. Evidence of tax status from
the Internal Revenue Service or a state department of taxation is not evidence of legal
existence.
3. Legal Authority to Contract with United States Government: You must provide written
evidence of your legal authority to contract with the Federal Government. Such evidence
includes a copy of the applicant’s bylaws or Articles of Incorporation, applicable state or local
statutes, a resolution from the applicant’s board of directors, or an opinion of counsel showing
that the applicant has the legal power to contract with the government. The provision of such
a document in and of itself, a copy of the applicant’s bylaws for example, does not provide
evidence of the authority. The document text must make specific reference to the authority.
Evidence of recent federal grants or other contracts with the federal government do provide
this evidence. If a consortium lacks the legal capacity to contract, each individual entity must
contract with RUS on its own behalf.
It is important that we know the exact name of the legal entity applying for the grant. For
example, some applicants have provided evidence that a related entity such as the school board
has legal authority to contract with the Federal government. Such evidence does not demonstrate
the legal existence of the school district that is the applicant or of the school district’s ability to
contract with the government. Applications that do not demonstrate both the applicant’s
legal existence as an entity that is eligible to apply for a grant and its legal authority to
contract with the United States Government will be returned as ineligible.
Use care in preparing your responses to the eligibility criteria shown above because the
information goes directly to your eligibility to apply. This is especially true for an applicant
whose legal name differs from its public name, whose legal name or status has changed in recent
years, or who is applying as a consortium. Bear in mind that the applicant shown in block 8 of
the SF 424, Application for Federal Assistance:
must be legally eligible to receive the award, and
must own and control items acquired under the grant.

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These considerations are particularly important if you are applying as a consortium. As defined
in 7 CFR 1703, a consortium is a combination or group of entities formed to undertake the
purposes for which the DLT award is requested. However, consortia can range in formality from
an established legal entity to an ad hoc group with no collective identity. What concerns RUS is
whether your consortium can contract with us. You should consult with your legal counsel to
determine whether your consortium has the legal capacity to contract with the Federal
government because it will have consequences should your application be chosen for an award.
Legal Ability to Contract with Federal Government – If your consortium has this
ability, the responses to the Eligibility Criteria above should be for the consortium as a
legal entity, not for any of the various entities that comprise the consortium. Also, a copy
of the consortium agreement should be provided with the application if such a document
has been created.
No Legal Ability to Contract with Federal Government – Some consortia, despite
having a formal existence, cannot contract with the Federal Government. More common
is an informal consortium or group of legal entities that have joined together primarily or
solely for the purpose of a DLT Grant application without having a formal consortium
identity.
When a consortium does not have the ability to contract with us, there are two possible
approaches to applying and the applicant should be aware of what that means both for the
application process and for the execution of a grant agreement should such a consortium
receive an award.
1. Apply under one Entity, not as a Consortium – Under this approach, one entity
would apply and the eligibility of the applicant would be based on that entity’s legal
eligibility. The consortium would not be considered. For example, if there are three
hospitals (A, B & C) taking part in a DLT Project, Hospital A would apply as the
legal entity with sole responsibility for executing the project.
Award Process - Bear in mind that if this approach is used, Hospital A would be the
only party to the grant agreement and it would have to maintain ownership and
control of everything acquired under the grant. Also, the Certifications submitted by
Hospital A under Tab H would have to cover all sites in the project including the
sites of Hospitals B and C. We have found that such an approach is usually
unacceptable to all parties, in this case, to all three hospitals.
2. Apply under a Lead Entity as a Consortium without Contract Authority –
Because it would be a burden to require applicants to go through the legal process of
establishing a consortium that can contract with us simply to apply, we accept
applications from less formal consortia. We do this with the understanding that
should the applicant win an award, the consortium arrangement would be formalized
in some manner at a later time.
Under this approach, the applicant submits its application under a consortium
name/lead entity. The consortium would designate one member to be the lead entity
and provide the eligibility criteria described below for that lead entity. If there are
three hospitals (A, B, & C), they could apply as Three Hospital Group/Hospital A,
where Three Hospital Group is the consortium name and Hospital A is the lead
entity.
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Make certain that the lead entity meets the eligibility criteria described above
because during the application process, the eligibility of the project’s
application will be based on the eligibility of that lead entity. For example,
consider a project in which six public schools will join with two private schools, one
of which is a single proprietorship. If this consortium were to choose the single
proprietorship as the lead entity, the application would be ineligible for funding
consideration because individual proprietorships are not eligible for DLT Grants.
Also, make certain that each entity submits a set of Certifications under Tab H.
Award Process – Should a consortium without contract authority be selected for an
award, there are two approaches possible for the execution of the grant documents.
a. The consortium can establish itself as an entity with the legal capacity to contract
with the Federal Government after the award is made. In such a case, the grant
agreement would be executed with this newly created consortium. This is the
recommended approach.
b. Otherwise, each individual entity constituting the consortium must be a party to
the grant agreement and those entities are jointly and severally responsible for the
entire project. In practice, the grant agreement is signed and executed by each
entity with the lead entity being responsible for requesting grant funds and
reporting requirements. In effect, the grant agreement creates a temporary
consortium specific to the DLT project.

C. Executive Summary
The Executive Summary gives reviewers their first overall view of the project area, the problems
that residents face, and how the proposed project will address those problems. This is your
opportunity to discuss the core aspects of the project. It should contain a concise description of
the project including:
1. A two paragraph abstract that describes your project in a nutshell. Think of how you would
describe it in a letter to your congressional representative or how you would want to see it
described in the newspaper.
2. A general overview of the telecommunications system to be developed, including the types of
equipment, technologies, and facilities proposed.
3. A description of the participating sites (hubs, hub/end-user, and end-user) or service territory (for
non-fixed site projects) and the number of rural residents who will be served at each hub/end-user
or end-user site. The sites (for fixed-site projects) or service territory (for non-fixed-site projects
must be consistent throughout your application including the SF-424, the Telecommunications
System Plan, the Budget, the Rurality Worksheet, and the NSLP Worksheet. If your sites or
service territory are not consistent throughout the application, your application will be returned as
ineligible. See D-1, Telecommunications System Plan & Scope of Work in Section IV of this
Application Guide, for extended discussion of how to categorize sites in your application.
DLT Grants cannot be awarded to projects that duplicate facilities. If any of the sites or service
territory in the project as described in the application are part of another application in FY 2011 or
were part of a project funded in the previous two DLT competitions (2009 & 2010), provide a
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brief description of the relationship between or among the projects. In particular, discuss how
match and grant funding for this project, if approved, would complement previous efforts.
Describe the status of previous projects and, in particular, the extent to which the funds have been
drawn for eligible grant purposes. Provide a more thorough discussion of project overlaps in the
Telecommunications System Plan, as described below. In the absence of an explanation, overlaps
in projects are assumed to be duplication and as a consequence, proposed grant and match budget
may be adjusted to remove such duplication.
4. A description of the types of distance learning or telemedicine services proposed and
whether those services will be offered via a fixed-site project or to a service territory where
the sites vary over time, such as a home health monitoring service. Remember that DLT
projects must propose specific projects to provide distance learning and/or telemedicine to
specific people. The DLT Program does not fund speculative proposals, i.e., the purchase of
equipment or software whose function will be determined later.
5. An explanation of how the project will address community needs, why your organization
requires financial assistance, and how the project benefits rural residents. A summary of
the total project cost including a breakdown of the grant requested, the proposed match, and
any other financial assistance required for purposes that are ineligible for grant or match but
which you feel are necessary for the project.
6. An explanation of who produced the grant application and the relation of the grant writer to
the applicant’s organization. In other words, was the application prepared by applicant staff,
an outside grant writer, an equipment vendor, or some other entity? With respect to
equipment vendors, we hear of applicants that make arrangements with vendors to prepare
their application with the understanding that should the applicant win an award, the awardee
will obtain its equipment from that vendor. Please be aware that we do not recognize and will
not enforce such a quid pro quo. We expect awardees to purchase equipment that best meets
the needs of their project at the best possible price. Vendors that choose to assist applicants
with their application should understand that they do so at their own risk.

D. Project Information
Eligible Grant Purposes are Identical to Eligible Match Purposes
In other words, to be considered as eligible matching funds, cash and in-kind contributions must
go toward items which would be eligible for grant funding if included as part of a grant request.
All items to be funded with match or grant must be obtained from an organization other than the
applicant or other entities participating in the applicant’s DLT project as hubs, hub/end-users, or
end-users, i.e., items must be procured from a third party. In the Application Guides of years
prior to 2006, third party procurement explicitly applied to category 2 (acquiring instructional
programming) and category 3 (technical assistance and instruction) items because it was in these
categories that applicants had requested to provide the items themselves. However, the logic that
leads to this restriction for category 2 & 3 items applies equally to category 1 (equipment).
There are a number of regulatory requirements that make this the only practical way to
administer the DLT program:

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1. Salaries and administrative costs of the applicant are not an eligible purpose. If an applicant
is also a vendor, it is administratively impossible to determine if the applicant’s salaries and
administrative costs are part of the vendor’s selling price.
2. Items acquired before the application deadline are not eligible for grant or match. If the
applicant is selling facilities to itself, we have no way to determine when the facilities were
obtained.
3. Should a grant be made to an applicant, grant and match are administered on the basis of
invoices from and purchase orders to third-party vendors. When the applicant obtains
facilities from a third party, it is in the applicant’s interest to obtain the lowest price and the
invoice is evidence of the actual price. If the applicant is selling facilities to itself, we lose the
assurance of reasonable pricing that third-party procurement provides.
Note: A vendor is eligible to participate in a DLT project either as the applicant or other
participant. However, actual advances and reimbursements of grant funds, and crediting of
matching funds, will be based on invoices submitted to the vendor from an entity not
participating in the project - in other words, what the vendor pays for the equipment, not what it
charges to others.
Eligible Purposes for Grant and Match
As you will see as you review the eligible purposes described below, the DLT Grant Program is
primarily focused on providing equipment that operates via telecommunications to rural endusers of telemedicine and distance learning. It is useful to keep in mind that while the equipment
is eligible, it does not fund the telecommunications that connects that equipment. In other words,
it does not fund communications links between sites (wireless or wireline) and it does not fund
telecommunications or Internet connections.
Remember that all equipment and services must be obtained from entities other than the
applicant. By applicant, we mean the organization that signed the SF-424 and the
organizations that have sites in the DLT project whether their participation is informal or
part of a formal consortium.
Grants (and eligible matching funds) can be expended only for the costs associated with the
initial capital assets associated with the project. This means that the capital assets must be new.
For example, the renewal of an existing lease for equipment or educational programming would
not be an eligible purpose. There are three categories of eligible purposes:
1. The first includes acquiring eligible equipment for eligible purposes. Acquisition can
be by purchase or lease. If leased, the cost of the lease during the three year life of the
grant is eligible. The following are examples of eligible equipment. This list is not
exhaustive. Neither does it convey blanket eligibility. A computer is not automatically
eligible. It must be used for an eligible purpose. Remember also that the purpose of the
DLT Grant program is to deliver education or medicine between remote sites via
telecommunications, not simply to furnish educational or medical technology. For
example, applicants will sometimes argue that all proposed equipment is eligible because
it is used 100% of the time to provide medical services. This is not always true. To be
eligible, it must be providing medical services that meet the grant definition of
telemedicine, i.e., via telecommunications between remote sites, not within one facility.

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Computer hardware and software
Audio and video equipment
Computer network components
Terminal equipment
Data terminal equipment
Interactive audio/video equipment
Original Equipment Manufacturer (OEM) or OEM authorized extended
warranties on eligible equipment up to the 3 year life of the grant
Inside wiring
In general, equipment not electronically interconnected to the grant and match funded
equipment is not eligible. The application must demonstrate both that the
predominant purpose (50% or more of use) of every line-item in the grant and
match budget meets the DLT Grant definition of distance learning and/or
telemedicine, and further, that none of the use is for ineligible purposes. If not the
primary purpose (less than 50% ), the applicant can propose that a portion of the line item
be budgeted for grant or match based on the proportion that does provide distance
learning or telemedicine. (See D-1, Telecommunications System Plan & Scope of Work
for more detail on apportioning DLT project benefit.)
2. The second provides for first-time acquisition of instructional programming that is a
capital asset (including the purchase or lease of instructional programming already on the
market). Renewals of instructional programming are not eligible. Also, expenses (such
as those for tuition, fees for coursework on a per course basis, or fees for cultural events
or virtual field trips) are not capital assets. As such they are not eligible.
3. The third includes technical assistance and instruction for using eligible equipment
(TA&I), including any related software; developing and modification of instructional
programming that is a capital asset and providing engineering or environmental studies
relating to the establishment or expansion of the phase of the project to be financed with
the grant. The costs for this category cannot exceed 10% of the grant amount
requested or 10% of the eligible matching funds calculated separately. For example,
if your proposed category three match is in-kind, it is limited to 10% of the proposed inkind match.
Ineligible Purposes for Grant or Match
None of the following purposes are eligible (see 7 CFR 1703.123):
Salaries, wages, or employee benefits to medical or educational personnel.
Salaries or administrative expenses of the applicant or the project including overhead
costs. Administrative expenses of the applicant include the normal costs of operation.
For example, software designed to keep track of student attendance or hospital billing is
an administrative expense, not a function of distance learning or telemedicine. Another
example is operational supplies such as paper, blank CDs, or spare ink cartridges. So is
rental of space, the cost of utilities, and maintenance, except for OEM extended
warranties as described above under eligible purposes. Some Federal grant programs
allow a percentage of funding for overhead costs. This is not an eligible DLT purpose.
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Acquiring, installing, or constructing telecommunications transmission facilities. DLT
projects are intended to deliver education or medicine between remote sites via
telecommunications, but they do not cover the transmissions facilities themselves. DLT
eligible purposes end at the terminal equipment that connects to a transmission facility.
Recurring or operating project expenses or costs such as fees for telecommunications,
Internet, electric service, rent, or tuition. (Leases to obtain equipment as described above
(under Eligible Purposes for Grant and Match) are not considered recurring costs.)
Each year applicants request funding for such things as wireless transmission systems or include
costs for Internet Access or other types of ―connectivity.‖ As the previous two bullets show,
DLT Grants fund equipment that operates via telecommunications, but it does not fund the
telecommunications itself, either through transmission equipment or purchased connectivity.
These are not eligible purposes for grant or match.
Medical equipment not having telemedicine as its principal and essential function.
Purchasing equipment that will be owned by a local exchange carrier or another
telecommunications service provider unless that service provider is the applicant.
Remember that entities financed through loans from Rural Development Utilities
Programs are not eligible for DLT grants.
Duplicating facilities already in place which provide distance learning or telemedicine
services.
Reimbursing your organization or others for costs incurred prior to the date we received
the completed application. For administrative convenience, we assume that date is the
application deadline for this year’s program. Applicants can begin the acquisition
process by placing an order after the application deadline. Should they win an award,
they can be reimbursed for such acquisitions. However, items received after the deadline,
but ordered before, are not eligible for reimbursement.
DLT application preparation costs.
Projects that only provide links between people located at the same physical facility.
This includes projects where several facilities are involved, but all the links are within
each facility. For projects that do not meet the DLT Grant Program definition of distance
learning or telemedicine, organizations should consider the DLT Loan or the Combo
Grant/Loan Program in the event these Loan Programs are funded. In the lending
programs, the definition of Distance Learning and Telemedicine is less specific to the
delivery of services via remote sites by telecommunications.
Site development including destruction or alteration of buildings. Equipment specific
modifications needed for the project to work such as soundproofing and lighting for a
video conferencing room are eligible, although modern video-conferencing equipment
does not require extensive room modifications. Building an addition, knocking out walls,
or replacing an electric service are not.
Purchasing land or buildings or for building construction.
Projects located in areas covered by the Coastal Barrier Resources Act.
Any other purposes not specifically contained in 7 CFR 1703.121.

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Any other purpose that the Administrator has not specifically approved.
Except as otherwise provided in 7 CFR 1703.112, grant funds shall not be used to
finance a project, in part, when success of the project is dependent upon the receipt
of additional financial assistance under Part 1703, Subpart E, or is dependent upon
the receipt of other funding that is not assured.
Eligible Purposes – Special Discussion about Electronic Medical Records (EMR) and other
technologies such as Picture Archive Communications System (PACS)
Because the subject of this discussion concerns telemedicine technologies, the following will be
restricted to that subject, but similar principles govern our administration of distance learning
technologies.
The Distance Learning and Telemedicine (DLT) Program is administered through three funding
options – a 100% grant, a mixture of loan and grant, and a 100% loan. Each option is tailored to
balance rural benefit and the cost to the government. In the 100% Grant Program, we have
implemented the statutory guidance by strictly targeting them to projects that extend and
improve the delivery of medical benefits into rural areas using the unique capabilities and
efficiencies of telecommunications to link medical providers and patients who are not at the
same facility.
We do this because it provides the greatest medical benefit to rural people through reduced travel
time and access to services previously unavailable close to home, thus mitigating the effects of
distance and low population density. Not every medical technology provides telemedicine as
defined and implemented under the 100% Grant Program. Some technology improvements, such as
replacements of physical records or analog technologies, do not meet the grant definition, or do so
only in part.
In short, the focus is on the patient, not the provider. While we recognize that technology that
benefits the doctor or hospital may trickle down to the rural person, we look for more direct
benefit under the grant program to maximize the medical benefit delivered by each grant dollar.
For example, we implemented the statutory direction not to fund ―administrative expenses‖ of
the applicant in the strictest sense. That is, we exclude from eligible grant and match purposes
all facilities except those that are clearly and unambiguously for the purpose of medical care.
Also, in line with this targeting of grant funds to provide the greatest medical benefit to rural
people, the 100% Grant Program specifically prohibits funding projects for communications
within one site (which we refer to as ―on campus‖ systems) because there is little direct benefit
to the rural person. If that person had to drive to the site before the project was implemented,
that person would still have to drive there after the project is built.
Electronic Medical Records - The fundamental purpose of electronic records is to replace
physical records. The purpose of such records is, at least in part, for things such as billing and
scheduling. EMR is marketed largely on this capability. Following the strict implementation of
the statutory direction appropriate to the 100% Grant Program as described above, we consider
billing and scheduling as examples of administrative functions of a medical facility, and
therefore, an administrative expense of the applicant. As such, they are not eligible for funding
under the 100% Grant Program.
In addition, the overwhelming use of EMR for medicine will be between a medical professional
and a patient within the same facility and little will be for transfers of records taken at one
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facility so as to benefit a patient at another facility. It is of little benefit to a rural patient whether
the records consulted by the medical professional are paper, electronic stored at that site, or
electronic stored elsewhere, if they are collected and used at only one facility. This simply
amounts to communications within a site, which is not an eligible purpose under the 100% Grant
Program.
This is not to say that EMR never provides telemedicine or that we will never fund it under the
Grant Program. We recognize that EMR allows for telemedicine to occur, such as when a
patient visits an emergency facility that is not the usual place to which that patient goes for
medical care. We also recognize that there will be growing use of EMR for telemedicine as time
goes on. While EMR allows for telemedicine, it is unlikely that the use of EMR will ever be
primarily for telemedicine as defined and implemented under the Grant Program, and we feel it
would not be a prudent use of scarce grant funds, to fund in full or to credit in full as match,
items which only provide a small percentage of such benefit when there are projects that do meet
the grant definition and have a greater impact on improving rural lives.
The concerns about whether equipment meets the grant definition of telemedicine apply to other
technologies. PACS and various technological replacements of earlier technology often have a
predominant ―on-campus‖ benefit. For example, when a hospital replaces its analog radiology
facility to PACS, there may be little or no use that meets the grant definition of telemedicine because
it is just a change from film to electronic storage with no medical benefit flowing through
telecommunications to a remote site. Applicants must thoroughly address how their project will
provide telemedicine that meets eligible purposes under the 100% Grant Program definition of
telemedicine, not just medical care.
EMR Under the Grant Program - In 2011, entire EMR systems remain partially fundable
based on a credible demonstration of the portion that meets the grant definition of telemedicine
as described above and elsewhere in this guide. We also will consider funding specific pieces of
EMR systems that provide service that meets the Grant Program definition.
EMR Under the Loan and Combo Programs – (At the time this document was prepared, there is
no Budget Authority for the Loan and Combo Programs. Should that Authority be established, the
Programs will be implemented as described here.) In FY 2011, entire EMR systems are fully eligible
under the Combination Loan/Grant Program. This is partly because ―on campus‖ facilities are an
eligible purpose under the Combo Program. Also, we implement the DLT Loan Programs (Combo
and 100% Loan) differently than the 100% Grant Program. In the Loan Programs, features that are
not exclusively medical but that are indirectly related to and very useful in the delivery of medical
care are not considered administrative costs of the applicant. Thus a feature such as scheduling is an
eligible purpose under the Combo Program. Another feature of the Combo Program is that it is
operated on a first-come, first-served basis, not as a competition. Because EMR is a better fit in the
Combo Program, we will continue special grant provisions for EMR in the 2011 Combo Program.
In 2011, EMR system Combos will consist of $1 of grant for every $4 of loan (instead of $1 of grant
for every $9 dollars of loan, as will be done in the balance of the Combo Program). In other words,
twenty percent of the eligible project total funding can come from grant funds up to a maximum
project of $1 million ($200,000 in grant, $800,000 in loan). For more detail on this and other DLT
loan programs, please refer to the FY 2011 Loan and Combination Loan/Grant Application Guide,
which will be made available shortly after we publish the Notice of Funds Availability (NOFA) in
the Federal Register establishing the FY 2011 grant and loan amounts, assuming that the Agency
receives Budget Authority for these Programs.
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D-1. Telecommunications System Plan & Scope of Work
A Telecommunications System Plan (TSP) is required as part of a complete application. The
TSP provides the reviewer with a thorough understanding of the project. The TSP in tandem
with the Budget is the foundation of the application and should be prepared with great attention
to detail. In particular, it shows the sites (hubs, hub/end-users, or end/users) that will participate
in the project and shows where the equipment will be located. In addition, the TSP shows how
the equipment is interconnected and how it accomplishes the distance learning or telemedicine
purposes of the project. Before getting to the details of how to present your TSP and Scope of
Work, we will address two subjects that are part of that process: Categorizing Sites and
apportioning DLT Project Benefit.

Categorizing Sites and End-Users
Program Purposes – The clear intent of the DLT Program as envisioned in the legislation
establishing the Program and regulation which implements the Program (7 CFR 1703) is to
benefit rural areas (20,000 or less). Scoring is based in large part on the beneficiaries of the
project, i.e., the end-users. In particular, the Rurality and NSLP scores are directly tied to the
end-users. It is important to note that the definition of ―end-user‖ in the regulation envisioned
only rural facilities such as rural elementary, secondary, and other educational institutions; rural
hospitals, primary care centers, or other rural community facilities. We encourage applicants to
bear this in mind and limit their projects to rural end-users. While we recognize that applicants
may desire to include urban (> 20,000) end-users in their project, the Agency reserves the
right to evaluate the benefit that flows to urban areas and reduce grant and match funds
budgeted for the benefit of urban end-users when that benefit is not necessary to benefit
rural end-users or incidental to the benefit to rural end-users.
It is important that the end-users on which the application is scored are an accurate
representation of who will benefit from the grant and match funds.
Internet Delivery Systems – From time to time, we receive applications from educational
institutions that wish to provide a curriculum via the Internet. Frequently, the applicant will
describe its ―target‖ audience as students in rural areas. However, if the offering will be
generally available over the Internet, such projects cannot be accurately scored for rural benefit
(Rurality) because the beneficiaries can be anywhere, not just in rural areas. While the intent
may be to serve rural areas, if the area cannot be accurately scored because it is geographically
undefined, the rural benefit cannot be measured, so we cannot consider it for funding.
Urban Sites - If grant or match funds will benefit an urban site, that site must be accounted for in
the scoring and budget. This is true even if no grant or match funds are expended at the urban
site, but the site benefits from grant or match funds expended elsewhere, say at a Hub facility
that serves them. If you wish to exclude an urban site that will benefit from the project because
of its potential to reduce a score, you will also need to remove any funds from the grant or match
budget that benefit that site. Conversely, imagine an interconnected system of 30 sites, but
where the proposed budget and project benefits will go to just four of those sites. Do not include
the other 26 sites to gain a better score merely because they are interconnected.

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Tip – The Rurality score should be an accurate reflection of the rural benefit of the project. Do
not attempt to improve your score by not mentioning urban sites that will benefit from your
project or by including superfluous rural sites. If your organization has 20 locations, and you do
not include them all in the scoring calculations, address why you chose not to include them. If
you do not explain the exclusion, we cannot evaluate whether or not the scores generated by the
sites you did include are an accurate reflection of the rural benefit of the project. By the same
token, do not attempt to improve your score by including rural interconnected sites as end-users
when the project benefit that accrues to those sites is minimal.
Remember, sites (for fixed site projects) and service territory (for non-fixed-site projects) must
be consistent throughout your application including this section, the SF-424, the Budget, the
Rurality Worksheet, and the NSLP Worksheet. If your sites or service territory are not consistent
throughout the application, your application cannot be evaluated and will be returned as
ineligible for funding consideration.
HUB - A pure hub receives no benefit of any kind from the project. It is either an electronic
connection point or it is exclusively a source of distance learning or telemedicine. Because no
benefit flows to a pure hub, we do not include it in the Rurality and NSLP score. This can be
important because Hubs are often located in urban areas.
However, most DLT project hubs are actually hub/end-users as described below and we start our
evaluation of an application with that presumption. To be considered a pure hub, the applicant
must address its designation of the pure Hub site and convincingly demonstrate that no benefit
flows to the hub site or to users at the hub site. In the absence of such a demonstration, the
Agency will make an independent determination and categorize the site based on our overall
experience with similar projects. The following are examples of pure hubs, although the third
example gives an illustration of a site that would not be funded in its entirety.
Pure Hub Examples:
1. A server is located in a school administration building. The server’s entire function is to
control distance learning equipment remotely located at each of 15 schools in the district. In
other words, it serves as an electronic hub. In this case, the Administration building site is a
pure hub. The Administration Building is excluded from the scoring and each of the 15
schools is scored as an end-user.
2. An urban school provides classes to five other schools that are shown as end-users on the
Rurality and NSLP Worksheets. The urban school provides classes to students at the five
schools but does not receive any courses from them. The DLT project items placed at the
urban school are dedicated to the five rural schools in the project. No grant or match items
are used at the urban school to provide courses to or receive courses from within the school or
from schools that are not shown as part of the DLT project. The urban school is a pure hub.
The five rural schools are scored as end-users on the Rurality and NSLP Worksheets.
3. A state operated Educational Resource Center serves students at all 804 public schools in the
state. No students are served at the Resource Center itself. The applicant proposes to install
video conferencing equipment at the Resource Center in order to provide distance learning to
seven rural schools. If the applicant can demonstrate that the equipment at the Resource

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Center is dedicated to and will benefit only the seven schools shown as end-users, it would be
an example of a pure hub. The Rurality and NSLP Worksheets would show the seven rural
schools as end-users.
If, however, the Resource Center will use that equipment to provide distance learning to any
of the other 797 schools which it serves, the seven schools shown on the scoring sheets as the
end-users are not the sole beneficiaries of the grant. All sites that benefit from the project
must be accounted for in the scoring and budget even if no funds are expended at some of
those sites. If the applicant does not wish to include the other schools that will benefit from
the DLT project investment at the Resource Center because of their negative effect on the
applicant’s score, it is possible that grant and match amounts for the equipment at the resource
center can be adjusted in proportion to the usage that can be attributed to the seven rural
schools included in the scoring. See below for detail on apportioning DLT project benefit.
Hub/End-User - A hub/end-user may perform functions associated with a hub such as electronic
switching or origination of content, but it also receives benefit at that site. Hub/end-users are
much more common in the DLT Program than pure hubs. A hub/end-user is considered the
same as an end-user for scoring purposes. Remember that this program is intended for end-users
in rural areas. If you include an urban hub/end-user in your project, the Agency reserves the
right to evaluate the end-user benefit that flows to the urban area and may reduce grant and
match funds budgeted for the benefit of urban end-users when that benefit is not necessary to
benefit rural end-users or incidental to the benefit to rural end-users.
Hub/End-User Examples:
1. A university medical center wants to create a teleradiology system along with seven rural
hospitals. The equipment at the university hospital will be used within the hospital and to
connect with national centers of expertise for the benefit of patients at the university medical
center and the seven rural hospitals. Because benefits flow to the university medical center, it
is a hub/end-user and must be accounted for. We recommend that the applicant apportion the
end-user benefit to the urban hospital and include funding at the urban site only for the hub
function. In such a case, the site would not be included in the Rurality or NSLP calculation.
See below for detail on apportioning DLT project benefit.
2. A suburban High School in an Urban Cluster of 12,000 houses the server that interconnects
itself and three other schools. Video-conferencing equipment is installed at all four schools.
The suburban high school and the three other schools both provide classes to and receive
classes from other schools in the project. The Rurality and NSLP Calculations show four
hub/end-user sites, the suburban high school and the three other schools.
End-User - An end-user is purely a beneficiary. Grant or match funds do not have to be
expended at a site to make it an end-user for scoring purposes. If grant or match funds
expended anywhere will benefit users at a site, that site must be accounted for in the scoring
and budget. Again, this program is intended for end-users in rural areas. Urban end-users are
not eligible for funding, but may need to be included in the scoring because of benefit they
receive from funding elsewhere.

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End-User Examples:
1. A rural high school will receive foreign language and higher mathematics courses via videoconferencing equipment that is part of the DLT project. These courses will come from a
larger high school that is a hub/end-user. The rural school will not provide any classes to
others and is classified as a pure end-user.
2. An urban high school that is not included in the grant or match budget. If it will receive
distance learning information via the DLT project which is the basis of the grant request, or if
grant or match funded equipment will benefit this site, it must generally be shown as an enduser for scoring purposes. If the applicant does not wish to include this site because it would
have an adverse effect on the applicant’s score, it is possible that the grant and match amounts
at other sites could be adjusted in proportion to usage by the end-users included in the scoring.
See below for more detail about apportioning DLT project benefit.

Apportioning DLT Project Benefit
DLT Grants are intended to reduce the effects of low population density and lack of economic
resources by using telecommunications to bring education and medical services to rural areas. In
short, the focus is on students and patients in rural areas, not on teachers and doctors or
institutional administrators. The scoring system (Rurality and NSLP in particular) is intended to
measure the benefit of the project to rural people by using population and economic
characteristics of the end-user sites where the service is provided as a proxy for the rural people
the project is designed to benefit. As part of our review of the application, we must make certain
that the project actually provides distance learning and/or telemedicine and that the end-users on
which the scores are calculated are an accurate representation of who will benefit from the
project. If sites not included in the scoring benefit from the project, they must be accounted for
in some manner so that the funding considered for grant and match is proportional to the benefit
that goes to the sites on which the application is scored.
For a line-item to be eligible in full for grant or match funding, the application must demonstrate
that:
1. None of the use is for ineligible purposes,
2. None of the use is to benefit sites not accounted for in the scoring, and
3. The predominant purpose (over 50% of use) of that line-item is for purposes that meet
the DLT Grant definition of distance learning or telemedicine.
If any part of a line-item is for an ineligible purpose, the line-item cannot be budgeted for grant
or match. If not the predominant purpose (over 50% of use) or if some of the use will benefit
sites not included in the scoring, the applicant can propose that a portion of the line-item be
budgeted for grant and/or match. That portion eligible for grant or match is that attributable to
the sites on which the project is scored. The balance must come from other funds.
Apportioning Illustrations: How does apportioning benefit work in practice?
Illustration 1 - No Apportioning Needed: In many cases, there will be no need to apportion.
Imagine a typical distance learning system in which ten rural schools are equipped with video
conferencing classrooms so that they can all exchange classes with each other. None of the
video conferencing equipment is used for communications within the school. All the equipment
is used for distance learning, i.e., transmitting and receiving classes via telecommunications to
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and from one of the other schools in the project and none is used to connect to schools not shown
as end-users. All ten schools are scored as hub/end-users on the Rurality and NSLP Worksheets.
The DLT percentage of use of the video-conferencing equipment is 100% for distance learning.
Illustration 2 - Ineligible Purposes: Other cases are not so straightforward. Grant and Match
funds cannot be used in the DLT Program to fund ineligible purposes. For example, Intenet
connectivity is not an eligible purpose so it must always be shown as zero percent DLT,
regardless of the percentage of time it is used by rural students. Bundling an ineligible purpose
with an eligible purpose does not change this. For example, a medical software package might
bundle billing and insurance functions along with functions that can be used to provide
telemedicine. Administrative costs of the applicant (billing and insurance) are not eligible
purposes (See eligible and ineligible purposes under D, Project Information, in Section IV of
this Guide). In cases like this, have the vendor apportion (break out) the costs of eligible and
ineligible purposes so that you can show them as a separate line-items in the budget. The lineitem for ineligible purposes must come from other funds - not grant or match.
The apportionment must be reasonable. If a software bundle provides thirty functions, and only
one is a DLT eligible purpose, it is not reasonable to suggest that 100% of the cost of the bundle
is for the one eligible purpose. The Agency will review the apportionment for reasonableness
and may adjust it based on its experience with similar systems. If breakout pricing to apportion
the ineligible purposes is not provided, the entire line-item is ineligible and must come from
other funds.
Illustration 3 - Purposes that are Neither Eligible Nor Ineligible: In some cases, a portion of a
line-item is for a purpose that while not specifically ineligible, does not meet the DLT Grant
Program definition of distance learning. Consider a computer that is integrated into a distance
learning classroom system. Imagine that it is used 55% of the time for distance learning and
45% of the time for ordinary Internet access and local use such as word processing. This
computer has a predominant use of distance learning. The balance of use, Internet access and
word processing, does not meet the DLT Grant definition of distance learning, but it is not
specifically ineligible. In this case, because the predominant use is for distance learning, the
entire computer would be eligible in the grant or match budget.
However, schools routinely purchase large numbers of computers for general use. While
connected to the Internet, they may not be integrated into the distance learning functions of the
DLT project in any way. In such a case, none of the computer’s use can be attributed to distance
learning so none of the computer’s cost can be included in the grant or match budget. In other
cases, the predominant use of the computer is not for distance learning. If a computer is used 5%
of the time for distance learning, it is not a good use of scarce grant funds to fund it in its entirety
or to consider the entire computer an eligible match. In this case, only the portion attributable to
DLT use (5%) is eligible for grant or match. The balance must come from other funds.
DLT % of Use - Reasonable Basis for Apportioning:
The sample budget forms include a column for the applicant to enter the DLT % of Use. The
percentage entered in this column is to reflect the portion of use that is attributable to eligible
DLT Grant purposes of the project, not simply to education or medicine. In other words, if an
applicant enters 100% in this column, it is claiming that the item is for a purpose that is 100%
eligible, i.e., it is solely for either distance learning or telemedicine between remote sites via
telecommunications as discussed above.

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The applicant may choose any reasonable method to demonstrate usage, but this is important, it
must demonstrate the basis for that usage, not merely assert it. If an applicant does not
address how the percentage was determined, or does not provide a reasonable and
satisfactory demonstration, it can expect the Agency to adjust the percentage based on our
experience with similar items. Among the bases for apportioning use would be time of usage
or numbers of users. However, as with apportionment of ineligible purposes discussed above,
the basis for apportionment must be demonstrated and must be reasonable.
Illustration 4: Consider this hypothetical example. Imagine a type of educational project where
every student and teacher is electronically connected to every other student and teacher. Assume
that the educational information that flows between students and teachers would meet the
definition of distance learning if each student were at a separate site connected through
telecommunications. An urban school plans to install this system to serve its 2,000 students at
one site. Because it is a single site system that does not connect remote sites via
telecommunications, it would not meet the DLT Grant Program definition of distance learning.
If the urban school were to connect 20 rural students at one rural school to their system via
telecommunications, the project would acquire a distance learning component. Based on the
number of students (20 ÷ 2,020 = 0.01), it would be reasonable to attribute 1% of the investment
at the urban school to distance learning and that amount would be eligible for grant or match.
The balance would have to come from other funds. If the applicant demonstrated that the rural
students will use the system twice as much as the urban students, it would be reasonable based
on usage to attribute 2% of the urban site equipment to distance learning. In this case, 2% of the
investment at the urban school would be eligible as grant or match. It would not be reasonable to
attribute 100% of the equipment at the urban school as benefiting the 20 rural students and seek
to fund 100% of the urban school equipment with grant or match.
The situation would be the same for an urban medical center that installs an in-hospital system.
A one-site system does not meet the Grant Program definition of telemedicine. If it were to
connect one rural clinic, it would add a telemedicine component. If 100 medical professionals
use the system within the hospital and only one uses it from the rural clinic, it would be
reasonable to attribute 1% of the equipment at the hospital to telemedicine. It would not be
reasonable to attribute 100% of the equipment at the hospital as benefiting the one rural clinic
and seek to fund 100% of the hospital equipment with grant or match.

Telecommunications System Plan Details
The TSP will aid the Agency in comprehending and evaluating your project. It is crucial that the
TSP provide the information in the numbered items below. Keep in mind that the eligible
purposes for grant and match are identical and the support information you provide here and
elsewhere in the application should be just as thorough and complete whether for items in your
grant request or in your proposed match. Remember also, that your application is evaluated for
eligibility and scored based on the material submitted by the deadline. Additional information
and clarifications not provided as part of the application as received by the deadline will not be
solicited or considered by the Agency.

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Number and organize your TSP Details as shown below. Include the following:
1. A description of the types of distance learning and telemedicine services proposed and a
statement that the project is either for a distance learning or telemedicine purpose. Describe
how the project as a whole meets the regulatory definition of distance learning and
telemedicine. If the project provides both distance learning and telemedicine services,
identify the predominant use of the system.
Remember that distance learning as defined by the regulation implies a curriculum with
measurable results delivered via telecommunications and stresses the connection of students
and teachers at remote sites. Not every use of technology is distance learning. Some
examples of technology that in isolation are not distance learning include:
General computer and whiteboard acquisitions. Computers and whiteboards are
becoming ubiquitous general use appliances. For example, it is increasingly
common that schools attempt to provide every student a computer, regardless of
whether that school has any distance learning in their curriculum. General
equipment acquisitions cannot be automatically considered distance learning
equipment.
Wireless connectivity. As with computers, many schools are now installing
wireless connectivity. These systems are generally used for internal
communications within a facility, not for distance learning. As such they would
not be eligible for grant or match funding.
Attendance software. Attendance is an administrative function. Administrative
costs are not an eligible purpose.
Ordinary access to the Internet, i.e., not part of a structured curriculum obtained
via the Internet. Giving a student access to the Internet for ―research‖ is not
distance learning any more than giving them access to the library is formal
education. The e-rate program is targeted directly at the goal of wiring schools
and connecting them to the Internet. The DLT Program is focused on connecting
students and teachers at remote locations.
Providing classroom video monitors that could potentially be used for distance
learning throughout a school, but without a demonstration in the application that
the applicant has a specific and coherent plan on how to do so.
Providing computers for word processing, homework, or for improving a
student’s ―technical literacy.‖ These are all worthy goals, but they do not meet
the Grant Program definition of distance learning.
Video-streaming of archived classes recorded at one school and viewed at the
same school on a server located at that school. Video streaming of archived
material can be a valuable adjunct to a distance learning system, but in isolation it
is not distance learning because the transfer does not involve telecommunications
between sites. In essence, this is like looking at a video tape, which is not
distance learning.
Telemedicine as defined by the regulation implies the delivery of medicine from medical
professionals at one site to patients and their medical professionals at other sites via
telecommunications. Telemedicine should reflect some benefit to rural residents either in
reduced travel time or access to services not otherwise available. If before the technology is

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installed, the patient visits the doctor’s office in a hospital for a consultation, and after the
technology is installed, the patient still visits the same doctor’s office for a consultation, and
the technology doesn’t provide any delivery of additional medicine from a remote site, your
project doesn’t provide any telemedicine or benefit to the rural resident. Some examples that
in isolation are not telemedicine include:
A computerized patient billing system where the physician and patient are at the
same site. This fails on two counts. First, the billing system does not deliver
medicine. It is an administrative function and administrative costs are not an
eligible purpose. Second, even if this function were eligible, the interaction is
between doctor and patient at the same site. It is a matter of indifference to the
patient whether the billing is manual or electronic. There is no medical benefit
delivered to the rural resident in terms of reduced travel time or access to
previously unavailable services that occurs through telecommunications.
Wireless connectivity. This is generally used for internal communications within
a facility, not for telemedicine.
General Technology Improvements - Many technology improvements can have
an internal or telemedicine use. For example, Electronic Intensive Care Units are
being installed both at rural hospitals for remote monitoring, and at urban
hospitals for internal use. The former would be eligible, the latter would not.
Equipment not electronically interconnected with the equipment that comprises
the telemedicine project. For example, a portable computer used for data entry by
a medical professional at a patient’s home and carried back to another point where
the data is transferred to another system. No telemedicine occurs at the home
because there is no telecommunications link out of the home.
Connecting physicians at home so they can attend to paperwork or consult
records, but not for use in delivery of medicine from that site to another.
2. A general description of the telecommunications facilities proposed for the project including
an explanation of how they will enable the project’s interconnection with other networks, if
that is relevant. This discussion should cover the entire project, including interconnected sites
for which no grant or match funds are budgeted. The discussion should be sufficiently
straightforward that a reasonably intelligent but non-expert person would understand how
your project delivers distance learning or telemedicine across the system and would also be
capable of explaining that operation to another person.
3. A map and/or a network diagram of the telecommunications system, and how the
distance learning or telemedicine equipment relates to that system. For fixed site
projects, each site must be represented on the map/diagram. This representation need not be
to scale, but it must be representational of your project, not generic. An application that
does not contain a map/diagram that shows each site cannot be evaluated and will be
returned as ineligible for funding consideration. For non-fixed sites projects, the applicant
is to provide a map of its official service territory as part of the Site Worksheet under Tab A.
Remember that this must be the official service territory as demonstrated by public
information. If you serve all of Lakeview County as chartered by the County, do not provide
a map showing that you serve only part of that County. If you offer your service to the entire
United States, do not provide a map showing that you serve only the rural portions.

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2011 DLT Grant Application Guide

4. A list that can be cross referenced with the map/diagram and the Budget of every line-item
in the Budget. Provide detailed descriptions of each line-item in the list. Both here and in
the Budget, make certain that the line-items are specific, not lump sums that cannot be
evaluated by us as to eligibility or reasonableness of cost. Provide specifics such as the
brand and model number, i.e., “VideoKing TX-90,‖ as opposed to ―One Video System.‖
Provide detail about items such as ―installation,‖ ―interfacing,‖ ―integration‖,
―programming,‖ or other generic terms that convey no specific information about what is
being proposed. An application that does not include this list and detail cannot be
evaluated and will be returned as ineligible for funding consideration.
Include the following detail for each line-item:
The percentage of use that can be attributed to purposes that meet the DLT
grant definition of distance learning and/or telemedicine and a
demonstration of how those percentages were determined. Both here and in
the Budget, for any portion of the item to be eligible as grant or match, the DLT
percentage of use must be greater-than-zero. In particular, all items for ineligible
purposes are to be shown with a DLT % of use of zero percent because ineligible
items are never eligible for grant or match. (See page above for more detail
about apportioning DLT project benefit. This percentage is entered on the
Overall Budget Worksheet which is discussed below. Examples are also
provided in the Budget section.) Remember that to be eligible in full for either
grant or match, the predominant use of each line-item must be for distance
learning and/or telemedicine and none of the use can be for ineligible purposes. If
the line-item will provide any ineligible purpose, no portion of the line-item can
be funded with match or grant. For items that provide no ineligible purposes, but
where the predominant use does not meet the DLT Grant Program definition of
distance learning or telemedicine, only the portion attributable to DLT purposes is
eligible for grant or match. The balance must come from other funds.
The DLT capabilities of all equipment and software that will be provided.
Information which supports the costs shown in the budget such as vendor
quotations. Quotes from multiple sources are recommended and such information
is valuable in preparing the Cost Effectiveness section (Tab F-4). Include
discussion of how the budgetary cost estimates were determined to be reasonable,
when the equipment will be obtained, and whether it will be purchased or leased.
5. Documentation of discussions with various technical sources, such as consultants, engineers,
product vendors or internal technical experts. Provide detailed cost estimates for operating
and maintaining the end-user equipment. Provide evidence that you evaluated alternative
equipment and technologies. These types of documentation will also be useful in the Cost
Effectiveness Category.
6. A discussion of whether the project will duplicate any adequate, established telemedicine or
distance learning services. As part of the application package, you will need to complete a
Nonduplication of Services Certificate, which is part of the Toolkit. Applications submitted
without a certification of nonduplication will be returned as ineligible.

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2011 DLT Grant Application Guide

Previous Grants - In particular, thoroughly discuss any DLT grants received from our
Agency in the previous two grant cycles (2009 & 2010) and how they would affect the project
proposed in the current application. This applies not only to prior grants received by the
current applicant, but to grant funding that may have gone to any of the end-users in the
current proposal via a grant received by another entity. Specifically address the progress of
any previous awards and the extent of grant and match funds expended toward completing
those projects.
Current Applications - In addition, discuss whether any of the sites in the current project are
included as participants in another application for a Fiscal Year 2011 DLT Grant.
In the absence of a thorough explanation, overlaps in projects are assumed to be duplication
and as a consequence, proposed grant and match budget may be adjusted to remove such
duplication.
7. A description of the consultations with the appropriate telecommunications carriers (including
interexchange carriers, cable television operators, enhanced service providers, providers of
satellite services and telecommunications equipment manufacturers and distributors) and the
anticipated role of such providers in the proposed telecommunications system.
Scope of Work
The scope of work explains what you plan to do. It is your opportunity to make a clear and
convincing presentation of how you will achieve the goals of your project. The scope of work
completes the picture for the reviewer. It discusses how your organization proposes to proceed
with the project, if funded. An application that does not include a scope of work cannot be
evaluated and will be returned as ineligible. The scope of work must include, at a minimum,
the following:
The specific activities to be performed under the project.
Who will carry out the activities.
The timeframes for accomplishing the project objectives and activities.

D-2. Budget
Note: The purposes for grant and match are identical and the support information you provide
here and elsewhere in the application should be just as thorough and complete whether for items
in your grant request or in your proposed match. Remember also, that your application is
evaluated for eligibility and scored based on the material submitted by the deadline. Additional
information and clarifications not provided as part of the application as received by the deadline
will not be solicited or considered by the Agency.
A budget is required. In tandem with the TSP discussed above, the budget is the foundation of
your application and should be prepared with great attention to detail. This section shows how to
present a budget for your organization’s proposed project. Your Budget should show each cost
as a line-item similar to the sample below. Both here and in the Telecommunications System
Plan, make certain that the line-items provide item-by-item detail. Do not enter lump sums
38

2011 DLT Grant Application Guide

that cannot be evaluated by us as to eligibility or reasonableness of cost. Provide detail such
as the brand and model number, i.e., “VideoKing TX-90, $5,600,‖ as opposed to ―One Video
System, $75,000 each site;‖ Installation,‖ $50,000; or ―Wiring, $100,000.‖ Remember that we
evaluate the entire project so show each site in the Budget whether it will be funded with the
grant, matching funds, or other funds. Even if a site does not need any funding, enter a
placeholder in the Budget so that it is clearly identified as part of the project.
As is discussed more thoroughly in E-3, Leveraging, in Section IV of this Guide, we
recommend that applicants propose cash matches and avoid in-kind matches. Cash matches are
unambiguous as to value and can be applied against any eligible item in the entire budget. An
in-kind match is harder to value and is specific to the in-kind item proposed. If the applicant
cannot demonstrate that the item has an established monetary value or if the item is determined
to be ineligible, the proposed match disappears when that item is removed from the grant and
match budget.
As a practical matter, there is no compelling reason for an applicant to propose an in-kind match.
Any in-kind items will generally be obtained by the applicant with cash after the application is
submitted. In other words, when an applicant proposes an in-kind match, it is in effect
committing cash with which the proposed in-kind item will be purchased at some point after the
application deadline. However, by proposing a specific in-kind item rather than cash, the
existence of the match is tied to the eligibility of that item. If that item is not eligible, either
categorically or because the Agency finds that it is not integral to eligible DLT purposes as
described in the application, the item would be removed from the budget and the proposed match
associated with that item disappears. This would reduce the proposed match which can affect the
Leveraging score and could even make an application ineligible, should the remaining match not
meet the 15% minimum required under the DLT Program.
Tip - Describing a match for a specific item as a cash match does not make it so. If matching
documentation specifies to which line-items the match must be applied, that proposed
match is in-kind, not cash. As such, it should be entered on the In-Kind Match Worksheet
described below. Remember that the crediting of a proposed in-kind match is dependent on the
eligibility of that line-item as discussed above.
Of course, projects typically require resources that are not eligible (see page 20 for a list of
ineligible purposes) for grant or match funding and, as a result, are not part of the eligible costs
described above. Costs incurred by your organization or contributed by others for ineligible
purposes typically include salaries, rent, fringe benefits, supplies, office space, Internet access
charges, utility expenses and other recurring charges. If shown at all, these should be shown in
full on both the Overall Budget Worksheet and the Other Funds Worksheet. Budget worksheets
are described below.
Budget Worksheets - The Toolkit provides three budget worksheets:
Overall Budget Worksheet: Show the entire project budget on this sheet in line-item form.
Include every line-item that will be part of the project regardless of the source of funds. In other
words, this sheet will show every aspect of the project, whether it is funded by the grant, by
matching funds, or by other funds.
Number each line-item in the first column. To assist us in our review, we ask that when you
show these line-items on other worksheets, you use the same line-item number rather than
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2011 DLT Grant Application Guide

numbering each sheet independently. For example, you may show 100 line-items on the
Overall Budget Worksheet. If line-items 9, 11, & 15 on that sheet are proposed as an in-kind
match, show them as line-items 9, 11, & 15 on the In-Kind Match Worksheet.
For each line-item, identify the site where the item will be placed. Provide a description, a unit
cost, the number of units, and the extended cost. In the last column, DLT % of use, enter the
percentage of use that is attributable to purposes that meet the DLT Grant Program definition of
distance learning and/or telemedicine. Remember, this column is for use of eligible equipment
that meets the grant definition, not simply how much it will be used. This percentage must be
developed and supported in the TSP. Undocumented assertions of use cannot be evaluated
as to eligibility by the Agency and can result in the item being moved to the Other Funds
Worksheet. All ineligible purposes are shown as zero % in the ―DLT % of Use‖ column. Also,
otherwise eligible items for which no grant funds are requested or which are not proposed as
match are also shown as zero % in the ―DLT % of Use‖ column. See below for detail about
apportioning DLT project benefit. Examples are also provided.
At the bottom of the sheet is a block labeled Budget Summary. Line A, Overall DLT Project
Budget, is the total project budget. The number entered here should match the number entered in
Block 18g of the SF-424, Application for Federal Assistance.
In-kind Match Worksheet: Before proposing an in-kind match, we strongly recommend you
review the discussion about in-kind matching in Section IV, E-3. If any in-kind match items
are proposed, show them on this sheet. This includes any specific items identified in the match
documentation letter. Listing specific items makes them a proposed in-kind match, regardless of
whether they are represented in that letter as a cash match. If you truly wish to propose a cash
match that can be applied against any eligible purpose, do not specify the items to which you
want the funds to apply. Remember to identify each line-item in the same manner as on the
Overall Budget Worksheet (line-item number, site, description, etc.).
Special Note About In-Kind Matches
Last year we saw a significant increase of in-kind match proposals, no doubt due to pressure on
budgets caused by the economic downturn. The purpose of matching funds in a competition is to
encourage something that would not otherwise occur, not to give an unfair competitive
advantage to entities that routinely make technology purchases over entities that do not. We
scrutinize in-kind matches carefully to ensure they are credible and integral parts of the grant
project. As is discussed in Section IV, E-3, there is no benefit to the applicant in proposing an
in-kind match unless it is something that the applicant is already planning on purchasing for
another purpose, in which case it is difficult to make the case that the purchase is an integral part
of the grant project. The proposed in-kind matches we see are usually general technology
purchases of items we do not tend to find in applications from those that propose a cash match.
They appear to be compiled by examining planned technology budgets and proposing anything
that can possibly be construed as having some connection to the project. In most cases, we do
not credit these proposed matches because the applicant does not demonstrate that they are a
credible and integral part of the grant project. A ―scavenger hunt‖ approach to matching funds is
not a successful strategy. It creates a large review burden for the Agency and only results in
disappointment for the applicant when they do not gain the Leveraging points they expected to
achieve.

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2011 DLT Grant Application Guide

Other Funds Worksheet: Show all purposes that will not be funded with grant or match on this
sheet. This would include each line-item that is either ineligible or for which grant or match
funds will not be requested or proposed. This includes every item on the Overall Budget
Worksheet that is entered as having as a ―DLT % of Use‖ of zero. In addition, it includes any
portions of line-items that are not predominantly for purposes which meet the Grant Program
definition of distance learning or telemedicine. For example, if the applicant demonstrates that
the use of a line-item can be apportioned as having a 25% ―DLT % of Use,‖ the 75% that is not
included in the grant or match budget is shown on this sheet. (See D-1, Telecommunications
System Plan & Scope of Work for detail about apportioning DLT project benefit.)
Remember to identify each line-item in the same manner as on the Overall Budget Worksheet
(line-item number, site, description, etc.).
Tip - The ―DLT % of Use” column on the Overall Budget Worksheet is used to show the
percentage of use attributable to approved grant and match purposes. It is not a measure of the
source of funding nor is it an indication of how much the line-item is used in the project. For
example, on a line-item proposed by the applicant as an in-kind match, do not enter zero %
because you intend it to come from your match. Remember that items shown at zero percent are
not eligible for either grant or match. Another example would be attendance software, which is
not eligible under the grant program because it is an administrative cost. If shown on the Overall
Budget Worksheet, it would be entered as zero % in the ―DLT % of Use‖ column, regardless of
whether it is used 100% of the time over the equipment financed by the project.

Budget Example - Overall Budget Worksheet:
Paper/Electronic Hybrid Application – We recognize that many applicants transcribe
our forms into electronic form. To assist in this, we are providing the Budget
Worksheets in Excel. If you have prepared your Budget in Excel and are submitting a
paper application, we encourage you to copy your Worksheets onto a CD or DVD and
attach it to the application.
Center City CC Site: The applicant, Center City Community College (Center City CC), plans a
Distance Learning Project with three high schools; Woodland, Valley, and Southland. Center
City CC will use the budgeted videoconferencing equipment to provide courses to the three high
schools, but will not receive distance learning from them. Neither will it use the budgeted
equipment to exchange distance learning on its campus or with any other sites not accounted for
in the Budget and scoring. This makes Center City CC a true hub, so can be excluded from the
Rurality and NSLP scoring.
Southland High is located in a relatively wealthy and urban area (> 20,000). The applicant could
request grant funds for Southland and include it as an end-user in the scoring, but this would
result in a much lower Rurality and NSLP score. Also, if the Agency determines that the grant
funds requested or the match funds proposed are not necessary to benefit rural end users, or will
provide more than incidental benefit to urban users, it may adjust the grant and match budget for
this site to remove urban benefit. Instead, the applicant chooses to use other funds for Southland
and apportion the funds budgeted at the hub to reflect the benefit that flows to the two end-users
who will earn the higher Rurality and NSLP scores, Woodland and Valley. In this case, the
applicant convincingly demonstrated in its Telecommunication Systems Plan that 40% of the
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2011 DLT Grant Application Guide

coursework will be provided to Southland with the balance going to the two rural schools. This
means that 60% of the videoconferencing investment at the hub (lines 1-7) can be attributed to
the sites that benefit from the DLT project funded by the grant and on which it is scored. This
percentage is entered onto the Overall Budget Worksheet in the ―DLT % of Use‖ Column.
Line-items 8 and 9 are for a software package that includes ineligible purposes. The Total
School package includes administrative functions such as attendance software and other
academic record-keeping that is ineligible for funding with either grant or match. However, the
package also provides functions that meet the DLT definition of distance learning. The applicant
has obtained pricing and the basis for that pricing from its vendor. The apportionment by the
vendor breaks out this software package into two line-items. The ineligible purposes are shown
as having zero percent DLT purpose on line eight, even though they will be used in the project.
The funds for this portion of the package must come from other funds. The eligible purposes are
shown as having a 60% percent DLT purpose based on the same demonstration of use discussed
above for lines 1-7. The 40% balance must come from other funds.
Line-items 9 and 10 are correctly shown as having zero percent DLT Use. Center City CC is not
an end-user in this project. Classroom computers (and the wiring associated with them) are enduser equipment. As such, they are not part of this DLT project and could have been left out of
the Budget.
Woodland and Valley High Sites: The project will provide both schools with essentially
identical equipment. Each will get a distance learning classroom and lab equipped with video
conferencing equipment (line-items 15-21 & 24 for Woodland and line-items 27-33 & 36 for
Valley). The applicant demonstrated in the Telecommunications System Plan that the
conferencing equipment will be used solely to receive distance learning so it is correctly entered
at 100% in the ―DLT % of Use‖ column.
In addition, the schools will install computers in other rooms (line-items 22, 34 and 35). The
classroom computers will be used primarily for word processing and ordinary access to the
Internet, which while not meeting the DLT Grant Program definition of distance learning, are not
specifically ineligible. However, they will also be used at times to take formal online course
work from the community college as part of the high school curriculum. The applicant
demonstrated in the TSP that 20% of the computer’s usage will be for this purpose. As a
consequence, it shows 20% DLT Use for the computers (line-items 22 and 34) as well as the
classroom wiring associated with the installation at Valley (line-item35).
Southland: As discussed above, the applicant did not include Southland in the scoring. As a
consequence, the funds budgeted at that site have a ―DLT % of Use‖ of zero for this project and
the funds must be provided from sources other than grant or match.
Budget Example - In-Kind Match Worksheet:
In this example, the applicant followed our recommendation to provide a cash match. If, for
example, a local store, not involved with the project as a vendor, wished to contribute the LCD
projector for Woodland High, it would be entered on this worksheet identified by the same lineitem number as on the Overall Budget Worksheet. (See E-3, Leveraging, in Section IV of this
guide for a more thorough discussion of cash and in-kind matching.)

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2011 DLT Grant Application Guide

Budget Example - Other Funds Worksheet:
Some line-items that are part of a DLT project are not eligible as either grant or match. These
funds must come from other sources. In addition, some line-items may not be predominantly
attributable to the DLT project. (See D-1, Telecommunications System Plan & Scope of
Work for more detail about apportioning DLT project benefit.) The balance of these lineitems must also come from other sources. The applicant shows these line-items on the
OtherFunds Worksheet. Identify each line-item with the same line number used for that item on
the on the Overall Funds Worksheet.
Items that are partially attributable to the project are shown on this sheet in the amount not
attributable to the project. Grant and match funds cannot be used to benefit sites not shown in
the scoring. In this case, the applicant had demonstrated in the TSP that 60% of line-items 1-7
were attributable to the sites on which the application is scored and 40% would benefit sites not
shown in the scoring. The 40% that must come from other funds is shown here. Similarly, the
applicant had demonstrated that 20% of line-items 22, 34, & 35 is attributable to the DLT
project. The balance of these line-items (80%) is shown here.
Items not eligible for grant or match are shown on this sheet in the full amount as shown on the
Overall Funds Worksheet. In this case, the applicant proposes a software package that provides
both administrative functions (ineligible) and DLT functions (eligible). The applicant had the
vendor provided breakout pricing and the basis for that pricing so that it could present the
ineligible and eligible purposes on separate lines. Line 8, for the ineligible purposes must come
entirely from other funds. Line 9, for the DLT Purposes has a 60% DLT percentage of use based
on the same attribution used for lines 1-7 described in the previous paragraph. The balance,
40%, must come from other funds and is shown on this worksheet.
Other ineligible items would also be shown here. For example, a building addition is not an
eligible purpose for grant or match. If an addition were part of the project, it would be shown on
both the Overall Budget and Other Funds Worksheet in the full amount. In this case, Center City
and Suburban High are not shown as end-users in the Rurality and NSLP calculations, so 100%
of line-items 9 & 10 as well as items 40-49 are shown on the Other Funds Worksheet.

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2011 DLT Grant Application Guide

DLT Project

Overall Budget Worksheet
(See D-1 and D-2 in Section IV of the Application Guide)
Line
Item
No.1

Site
Name2

1
2
3
4
5
6

Center CC
Center CC
Center CC
Center CC
Center CC
Center CC

7

Center CC

8
9
10
11
12
13
14
15
16
17

Center CC
Center CC
Center CC
Center CC

18
19

Woodland HS
Woodland HS
Woodland HS
Woodland HS
Woodland HS
Woodland HS
Woodland HS

20
21

Woodland HS
Woodland HS

22

Woodland HS

23
24
25

Unit
Cost

Description
Moderncom 3000 Server
Poliburg 1776 Video Codec
Tobsung T-98.6 DVD VCR Combo
DV 2020X Digital Video Camera
Illumimax 120/80 LCD Projector
Micropixel P-5 5 Megapixel Document Camera
Opus-infinity No. 4601 Mixer w lavalier and handheld
microphones
Total School Sftwr Pkg - Ineligible (see TSP)
Total School Sftwr Pkg- DLT Eligible (see TSP)
Omigosh Model 3-TBSP Classroom computers
Wire Classroom computers into system
Center City CC Subtotal
Poliburg Intl 1776 Video Codec
Tobsung T-98.6 DVD VCR Combo
DV 2020X Digital Video Camera
Illumimax 120/80 LCD Projector
Micropixel P-5 5 Megapixel Document Camera
Opus-infinity No. 4601 Mixer w lavalier and handheld
microphones
Dull 24 computer distance learning cart for Distance
Learning Lab
Omigosh 3TBSP Classroom computers
Existing classroom wiring sufficient
Wire Dist Learning Lab and video-conf. equip into
system
Woodland HS Subtotal

No.

Extended
Cost

$2,125
$9,675
$1,480
$940
$1,420
$870

1
1
1
1
1
1

$2,125
$9,675
$1,480
$940
$1,420
$870

60
60
60
60
60
60

$1,870

1

$1,870

60
0
0
0
0
100
100
100
100
100

$750
$14,800

200
1

$9,675
$1,480
$940
$1,420
$870

1
1
1
1
1

$37,600
$97,400
$150,000
$14,800
$318,180
$9,675
$1,480
$940
$1,420
$870

$1,870

1

$1,870

100

$21,780

1

$21,780

100

150
n/a

$112,500
0

20
n/a

1

$11,340

100

$750
n/a
$11,340

$161,875

Overall Project Budget – Page 1 Subtotal

A.
B.
C.
D.
E.

DLT %
of Use3

Budget Summary
4
(Sum of page 1 and continuation sheet subtotals) Overall DLT Project Budget
5
(as documented under Tab E-3) Less Proposed Cash Match
5
(from In-Kind Match Worksheet) Less Proposed In-Kind Match
(from Other Funds Worksheet) Less Other Funds
DLT Grant Request (A – B – C – D = E)

480,055
$790,065
$43,000
0
$586,851
$160,214

1. Use the line-item number established on the Overall Budget Worksheet(s) on the other budget worksheets. If line-item 16 on the Overall Sheet is ineligible, show it
as item 16 on the Other Funds Worksheet. Don’t start a new numbering system on each sheet.
2. For non-fixed site applications, show the operational service center out of which the financed equipment will operate.
3. This number refers to the % of use that meets the DLT Grant definition of distance learning or telemedicine, the portion that is eligible for either grant or match
funding. Ineligible items or items for which no funding is requested are shown as zero percent, regardless of their use in the project.
4. Line A is the sum of all DLT project extended costs as shown on this page and any continuation sheets. It includes the grant request and all proposed matches, as
well as ineligible funds that have been included in the budget.
5. Matching funds (lines B & C) must be properly documented under Tab E-3 of your application as described in detail in the Application Guide. Any portion
that is not will not be credited as an eligible match.

Place this Worksheet under Tab D-2 of your Application
44

2011 DLT Grant Application Guide

Overall Budget Worksheet (Continuation)
Line
Item
No.1

Site
Name2

26
27
28
29
30

Valley HS
Valley HS
Valley HS
Valley HS
Valley HS

31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47

Unit
Cost

Description

Poliburg Intl 1776 Video Codec
Tobsung T-98.6 DVD VCR Combo
DV 2020X Digital Video Camera
Illumimax 120/80 LCD Projector
Micropixel P-5 5 Megapixel Document Camera
Opus-infinity No. 4601 Mixer w lavalier and handheld
Valley HS
microphones
Dull 24 computer distance learning cart for Distance
Valley HS
Learning Lab
Valley HS
Omigosh 3TBSP Classroom computers
Valley HS
Wire additional classrooms
Wire Dist Learning Lab and video-conf. equip into
Valley HS
system
Valley HS Subtotal
Southland HS Poliburg Intl 1776 Video Codec
Southland HS Tobsung T-98.6 DVD VCR Combo
Southland HS DV 2020X Digital Video Camera
Southland HS Illumimax 120/80 LCD Projector
Southland HS Micropixel P-5 5 Megapixel Document Camera
Southland HS HS Opus-infinity No. 4601 Mixer w lavalier and handheld
microphones
Southland HS Dull 24 computer distance learning cart for Distance
Learning Lab
Southland HS Omigosh 3TBSP Classroom computers
Southland HS Wire additional classrooms
Wire Dist Learning Lab and video-conf. equip into
Southland HS
system
Suburban HS Subtotal

No.

Extended
Cost

$9,675
$1,480
$940
$1,420
$870

1
1
1
1
1

$9,675
$1,480
$940
$1,420
$870

100
100
100
100
100

$1,870

1

$1,870

100

$21,780

1

$21,780

100

$750
$2,480

80
1

$60,000
$2,480

20
20

$11,340

1

$11,340

100

$9,675
$1,480
$940
$1,420
$870

1
1
1
1
1

$111,855
$9,675
$1,480
$940
$1,420
$870

0
0
0
0
0

$1,870

1

$1,870

0

$21,780

1

$21,780

0

$750
$11,450

180
1

$135,000
$11,450

0
0

$13,670

1

$13,670

0

Overall DLT Project Budget – Page 2 Subtotal

$198,155

$310,010

1., 2., & 3. See footnotes on 1st page of Overall Budget Worksheet

Place this sheet with other budget sheets under Tab D-2

45

DLT %
of Use3

2011 DLT Grant Application Guide

DLT Project

In-Kind Match Worksheet
(See D-1, D-2, & E-3 in Section IV of the Application Guide)
Proposed Matching Funds are generally cash. If any of the line-items shown on the Overall Budget Worksheet
are specified in the match documentation, they are in-kind. Show them below in the same manner (line-item #,
site name, description) as on the Overall Budget Worksheet. If only a portion is attributable to the DLT project,
show that portion here and the balance that is not eligible on the Other Funds Worksheet. In the right column,
clearly identify the source. Remember to document proposed matching funds under Tab E-3, otherwise they
will not be credited as an eligible match.
Line
Item
No.

Site
Name

In-Kind
Cost

Description

Source

C. Total Proposed In-Kind Match
(Insert this number in line C of the Budget Summary
on the Overall Budget Worksheet)

Make copies of this sheet if needed and label them “continuation.” Place this sheet with
other budget sheets under Tab D-2
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2011 DLT Grant Application Guide

DLT Project

Other Funds Worksheet
(See D-1 & D-2 in Section IV of the Application Guide)
Some line-items included in a DLT Project Budget are not eligible as either grant or match. The funds for these
must come from other sources and are designated ―Other Funds.‖ Some line-items are only partially eligible as
grant or match. The balance of these must also come from other sources. Show all other funds below in the
same manner (line-item #, site name, and description) as on the Overall Budget Worksheet. Show the ineligible
line-item cost (or portion thereof) in the ―other fund cost‖ column adjacent to the source of that funding.
Line
Item
No.

Site
Name

1
2
3
4
5

Center CC
Center CC
Center CC
Center CC
Center CC

6

Center CC

7

Center CC

8
9

Center CC
Center CC

10

Center CC

11

Center CC

20

Woodland HS

33
34

Valley HS
Valley HS

37
38
39
40

Southland HS
Southland HS
Southland HS
Southland HS
Southland HS

41
42
43

Southland HS
Southland HS

44
45

Southland HS
Southland HS

46

Southland HS

Other Fund
Cost

Description
Moderncom 3000 Server
Poliburg 1776 Video Codec
Tobsung T-98.6 DVD VCR Combo
DV 2020X Digital Video Camera
Illumimax 120/80 LCD Projector
Micropixel P-5 5 Megapixel Document
Camera
Opus-infinity No. 4601 Mixer w lavalier and
handheld microphones
Total School Sftwr Pkg - Ineligible (see TSP)
Total School Sftwr Pkg- DLT Eligible (see TSP)
Omigosh Model 3-TBSP Classroom
computers
Wire Classroom computers into system

Source

$850
$3,870
$592
$376
$568

Center CC
Center CC
Center CC
Center CC
Center CC

$348

Center CC

$748

Center CC

$37,600
$38,960

Center CC
Center CC

$150,000

Center CC

14,800

Center CC

Omigosh 3TBSP Classroom computers

$90,000

Woodland HS

Omigosh 3Tbsp Classroom computers
Wire additional classroom

$48,000
$1,984

Valley HS
Valley HS

$9,675
$1,480
$940
$1,420

Suburban HS
Suburban HS
Suburban HS
Suburban HS

$870

Suburban HS

$1,870

Suburban HS

$21,780

Suburban HS

$135,000
$11,450

Suburban HS
Suburban HS

$13,670

Suburban HS

Poliburg Intl 1776 Video Codec
Tobsung T-98.6 DVD VCR Combo
DV 2020X Digital Video Camera
Illumimax 120/80 LCD Projector
Micropixel P-5 5 Megapixel Document
Camera
Opus-infinity No. 4601 Mixer w lavalier and
handheld microphones
Dull 24 computer distance learning cart for
Distance Learning Lab
Omigosh 3Tbsp Classroom computers
Wire additional classroom
Wire Dist Lrn :Lab and vid-conf. equip into
system

D. Total Proposed Other Funds
(Insert this number in line D of the Budget Summary
on the Overall Budget Worksheet)

$586,851

Make copies of this sheet if needed and label them ―continuation.‖ Place this sheet with other
budget sheets under Tab D-2
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2011 DLT Grant Application Guide

Notes for Budget Example
Total Grant Request:

$160,214

Total Proposed Match:

$43,000

DLT grants require a 15% minimum match
To calculate the match percentage:
Matching contributions Proposed Grant Amount x 100 = Match %
($43,000 $160,214) x 100 = 26.84%
Calculation of 10% Rule for Category 3 Costs (See D, Project Information, in Section IV
of this Application Guide)
There are three categories of eligible costs. The third category includes things like training
and the development of instructional programming. Category three costs are limited to 10% of
the grant request and/or match calculated separately. The budget above does not include any
of these costs. If it did, the costs could would be limited as follows:
10% of the Grant Request = $16,021
10% of the match = $4,300

D-3. Financial Information and Sustainability
The DLT program is focused on sustainability. Planning studies, research projects, and short-term
demonstration projects of less than life of the award (three years) will not be considered.
Provide a narrative description that demonstrates your project’s feasibility. Address the technical and
programmatic expertise necessary to undertake and complete the project. Show how this expertise will
ensure a sustainable project. You should also address the resources devoted to the project, and whether
these resources will sustain the project. Applications submitted without a Financial Information
and Sustainability Section cannot be evaluated and will be returned as ineligible for funding
consideration. Place this section under Tab D-3 of your application. Your narrative should include
all assumptions and the following information:
1. A description of the project’s revenues and expenses.
2. Evidence of cost sharing arrangements among hub and end-user sites, if applicable.
3. Identification of any other items that may affect feasibility or sustainability of the project.
4. A demonstration that the benefits, including cost savings, of the DLT grant pass through to
those receiving services from the project.

D-4. Statement of Experience
Provide a written narrative describing your organization’s demonstrated capability and experience in
operating an educational or health care endeavor and any project similar to the proposed project.
Experience in a similar project is desirable but not required. If your organization does not have
experience with projects similar to the proposed project, you should explain how you plan to overcome
this. Place this narrative under Tab D-4 or your Application.

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2011 DLT Grant Application Guide

E. Objective Scoring Supporting Documentation

E-1. Rurality
Rurality is the term we use to describe how rural your DLT project’s service area is. In other words, it
is intended to be an accurate measure of rural benefit. We ask you to present an estimated Rurality
score in your application. A Rurality Worksheet is provided in the Toolkit for this purpose. The
Agency will review your estimate and correct it if necessary.
This category is scored on average population as described below:
Your project must score at least 20 points to qualify for the DLT Program competition.
Your project may obtain a higher score, up to a total of 45 points, depending on the relative
rurality of the project service area.
We use the following definitions as determined by the 2000 Decennial Census to evaluate
Rurality. (Note that the 2010 Census is being released over time. As of the writing of this Application
Guide, the 2010 Urban/Rural update, which defines Urbanized Area, Urban Cluster, and Census Rural,
is scheduled for release in October of 2012. As a result, we will continue to use statistics from the
2000 Census for the 2011 competition.) The Census defines an ―Urbanized Area‖ as being a
population center of 50,000 or more. It defines an ―Urban Cluster‖ as having a population of between
2,500 and 49,999. It defines a ―Rural‖ area as having no population center of 2,500 or more.
1. EXCEPTIONALLY RURAL AREA – 5,000 and under. Any area of the United States not
included within the boundary as defined by the US Census of an Urbanized Area (UA) or of an
Urban Cluster (UC) having a population in excess of 5,000 inhabitants. This includes areas within
the boundary of urban clusters of 5000 and under as well as areas that are outside of any Urbanized
Area or Urban Cluster.
2. RURAL AREA – 5,001-10,000. Any area of the United States included within the boundary as
defined by the US Census of an Urban Cluster having a population over 5,000 but not in excess of
10,000 inhabitants.
3. MID-RURAL AREA – 10,001-20,000. Any area of the United States included within the
boundary as defined by the US Census of an Urban Cluster having a population over 10,000 and
not in excess of 20,000 inhabitants.
4. URBAN AREA - Over 20,000. Any area of the United States included within the boundary of an
Urbanized Area or within the boundary of an Urban Cluster in excess of 20,000 inhabitants.
Remember that the DLT program is intended to benefit rural areas (20,000 or less). The Agency
reserves the right to evaluate the benefit that flows to urban areas and reduce grant and match funds
budgeted for the benefit of urban end-users when that benefit is not necessary to benefit rural endusers or incidental to the benefit to rural end-users.
Site Location
Exceptionally Rural Area
Rural Area
Mid-Rural Area
Urban Area
49

Points
45
30
15
0

2011 DLT Grant Application Guide

The Rurality Score by Type of Project – Fixed, Mobile, and Variable Sites
Tips:
As you prepare your Rurality data, if you find you are having problems finding the data, we
recommend that you repeat each step of the several examples presented below to help you
become familiar with the Census site.
You may find that your browser blocks certain ―pop-up images‖ from the Census site. If so,
you will need to turn off the blocker to use every feature. Internet Explorer will tell you it has
blocked a pop-up by placing a message under the toolbar in the top left corner of your screen.
Click on that message and it will allow you to turn off the blocker for this site. Other browsers
provide similar adjustments.
Most DLT projects operate at fixed sites such as schools or medical facilities. For these traditional
DLT projects, the Rurality score as described below is based on the population associated with each
end-user site. A subcategory of a fixed site project is a mobile system that sequentially serves fixed
sites.
In recent years, we have begun to receive applications from projects where the end-user sites are not
fixed. Although we sometimes receive distance learning projects along this line, to date, the non-fixed
site category primarily comprises two types of telemedicine projects. In both cases, the end-user sites
vary over time with need:
Home Health Care Systems – These typically involve either the placement of medical monitoring
equipment at the home or the provision of equipment for visiting nurses so that they and the
patients they visit can interact with medical professionals located at a distant site. In this way,
medical monitoring can be performed elsewhere via telecommunications and care can be delivered
into the home via telecommunications.
Ambulance Systems – These typically involve monitoring, pre-admittance testing, and interactions
between the medical professionals in the ambulance and those in the emergency room, all
conveyed via telecommunications.
End-user sites that vary over time were not contemplated when the regulation was written. It is clearly
not a fair measure of the rural benefit of such projects to base the Rurality score entirely on the fixed
sites of such a system, such as the location of the nurse’s hospital headquarters or the facility where the
ambulance is parked when off duty. (This was the method used when these types of applications were
first submitted.) In the first place, those sites do not represent the sites where the benefit of the project
is delivered. Second, both the nurse’s headquarters and ambulance storage area are likely to be located
in the most urban community in the area regardless of the extent of their rural service territory. On the
other hand, it is not a fair method of determining rural benefit if we allow the applicant to choose its
Rurality score by selecting to include in its Rurality calculation only the rural locations in its service
area when some, or even the majority of the people it serves, are in Urban Areas. Neither can we rely
on an applicant’s assurance that it will only use the funded equipment in its rural areas. We must
operate under the assumption that from both a practical standpoint and from a medical ethics
standpoint, equipment will be used based on medical need, not customer location.
In as much as we recognize such uses of telecommunications can provide important benefits to rural
areas, we have specified a method of determining Rurality for non-fixed site projects - a method based

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2011 DLT Grant Application Guide

on the idea that each potential end-user in the service territory is an actual end-user. This is a method
that is consistent with the intent and spirit of the regulation while providing a measure of rural benefit
that is reasonably comparable to that captured by the fixed-site method. In the discussion below, we
will discuss two methods for determining a Rurality score based on the nature of the project, i.e, fixed
site or variable site.
Mixed Projects - We strongly recommend that you do not mix fixed site, mobile, or non-fixed site
projects in one application. We have no administratively practical way to evaluate and score projects
that combine fixed, mobile, and variable sites, so do not submit an application that mixes them. If you
have this situation, we recommend you separate the projects and submit multiple applications that will
be evaluated and scored independently. If you do not follow this recommendation, we will score
mixed projects by evaluating the fixed, mobile, and non-fixed portions separately, and we will assign
the lower score to the entire project. For example, if a mixed project has a fixed site Rurality score of
30 points and a non-fixed-site score of 26, we will evaluate the entire application as having a Rurality
score of 26 points. A similar process will be used for assigning other scores.
Undefined Service Territories - Also, we have no administratively practical way to evaluate and
score projects that do not have a defined set of users, such as a general offering made to anyone with
Internet access. Such projects can not be considered for funding under the DLT Grant Program.

Rurality Score for Projects in which all End-User Sites are Fixed
Enter each hub, hub/end-user and end-user site on the Rurality Worksheet, showing its location in
parentheses. Although pure hubs are not included in the calculation, the Agency will need this data to
recalculate the score in the event that we determine that the site should be included. Place the sites in
the same order and use the same numbering as on the Site Worksheet and NSLP Worksheet. Use
Census Urban and Rural Area population data along with the table above (it is also printed on the
Rurality Worksheet) to determine Rurality points for each site. To document the numbers, attach a
2000 Census population sheet and map for each site’s location behind the Worksheet as described
below. The population to be used will be Census Urban and Rural Area data. Start the process from
the main Legacy Fact Finder Page of the Census at this website:
factfinder.census.gov/home/saff/main.html?_lang=en

Image 1
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2011 DLT Grant Application Guide

If you have used FactFinder in the past, you will notice some changes as the Census migrates to a new
web interface as described in the center section above. In particular, the mainpage of the FactFinder
site features a discussion of the ―New American FactFinder‖ and provides a link to the factfinder2
website. If you were to click on that link, you would see a screen like the one in Image 2.

Image 2
Because the Urban and Rural Area Census 2010 information is not scheduled for release until October
of 2012, we will continue to use the legacy FactFinder. Look at the left column of the legacy
FactFinder mainpage, click on ―Data Sets,‖ and then click on the drop-down menu ―Decennial
Census.‖

Image 3

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2011 DLT Grant Application Guide

The data sets of interest are circled below. The first we will use is ―reference maps.‖ The mapping
tool found here is quite versatile. It allows zooming and precise identification of a site’s location with
respect to whether it is inside a Census Urban Area.

Image 4
When you click on ―reference maps,‖ it will bring up a map of the U.S. Click on ―Reposition on A
street address or ZIP code.‖ Enter the State College zip code ―16801‖ to bring up a detail map.

Image 5

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2011 DLT Grant Application Guide

When the detail map appears, click on ―Change Boundaries and Features.‖ Remove the checks from
every item except ―2000 Urban Areas,‖ then click the ―Update‖ Button. If you wish, you may leave
the block checked for ―2000 Place‖ in the ―Label Column,‖ not the ―Boundary Column. You want the
jurisdictional boundaries to disappear, but it is sometimes useful to have the place names remain.

Image 6
This will alter the map you brought up based on the zip code so that is shows only the Census rural
area (in yellow) and the State College Urbanized Area (in pink cross hatching). You can use the
circled features to re-center and zoom until you precisely locate your site. To re-center, click on the
―hand‖ button, move your cursor to the location you wish to center, and drag it to the center while
holding down the left mouse button.

Image 7
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2011 DLT Grant Application Guide

Print a Census page with a detail map like the one below. Include it in your application as
documentation for this site behind your Rurality Worksheet. Show the site’s exact location on this
map. In this case, we have entered a hypothetical location on Porter Road in the yellow area of
College Township at the top. A site located here is Census rural and would score 45 points. If the site
were inside the checkered territory, you would designate it ―Urbanized Area‖ and you use the State
College Urbanized Area population. Do not enter the population for College Township, or any other
political jurisdiction in which the site may happen to be located. The method for determining the State
College Urbanized Area population is described below:

Image 8

Click on ―Data Sets,‖ circled in image 8. This will return you to Image 4. Click on ―Detailed Tables.‖
It will bring up the screen below. First select ―Urban Area‖ from the drop down menu under ―Select a
geographic type.‖ Wait while the website populates the next block with every ―Urbanized Area‖ and
Urban Cluster‖ in the country. Scroll down to ―State College Urbanized Area,‖ highlight it, then click
the ―add‖ button. When it appears under ―current geography selections,‖ click on ―next.‖

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2011 DLT Grant Application Guide

Image 9
Choose P1, P2, and any other items in which you are interested and which may prove useful for your
Needs and Benefits Section. Add them to the selection then press ―show results.‖

Image 10

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2011 DLT Grant Application Guide

This will bring up the page below. Enter this population on your Rurality Worksheet, which yields a
score of zero points, and attach a copy of this page as documentation behind the Worksheet.

Image 11
If outside a place designated urban by the Census, such as in the example shown above in image 8,
print a Census Urban Area map that clearly shows the location of the site as being outside of the
checkered Urban Area using the techniques described above. In extremely rural areas with no nearby
population centers, this may require that you zoom out until the closest Census Urbanized Area or
Urban Cluster shows on the map. Print this map, precisely identify your site’s location, and include it
as documentation behind the Rurality Worksheet.
In some cases, there may be ambiguity about your site’s precise location. For example, if your
organization has moved recently. (See the discussion about precise site identification on pages 15
through 17 of this Guide.) If there is any ambiguity, include ancillary identifying information and
maps such as latitude and longitude or printouts from Internet sites such as Mapquest or Google Maps.
Sometimes local jurisdictions produce maps that can be useful. Any end-user site for which the
applicant does not provide precise location identification and corresponding Census
documentation will be evaluated as urban (zero points).
Remember that for fixed sites, the information must be consistent throughout the application including
on the Rurality and NSLP Worksheets, the Site Worksheet attachment to the SF-424, the Executive
Summary, the Telecommunications System Plan, and the Budget. If the end-user sites are not
consistent, your application cannot be evaluated and will be returned as ineligible for funding
consideration. (For projects where the end-user sites are not fixed, see below.)
After you have entered all your sites and the corresponding population on the Rurality Worksheet,
calculate your estimated score by taking the average of the sites you designated as hub/end-users and
end-users. Do not include pure Hubs in the calculation. Remember that we will evaluate sites you
designate as pure hubs to determine if they are also end-users. If we make that finding, we will
recalculate your score on that basis.
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2011 DLT Grant Application Guide

Excluded Sites - Your project may benefit urban sites (>20,000) that would not score well in the
Rurality and NSLP Categories. Remember that the DLT Grant Program is intended to benefit rural
sites. We encourage applicants to exclude urban end-users in their project. Should you choose to
include urban end-users, but wish to exclude such sites from the calculations, show the excluded sites
separately on the Worksheets with a clear indication that they have been excluded from the
calculations. In such cases, all funds that benefit the excluded sites must come from other funds.
None can be included in the grant or match budget. This is true even if the funds are used for
facilities located at a Hub/End-user site that is included in the Rurality calculation. (See D-1,
Telecommunications System Plan, for detail on apportioning DLT project benefit.)
Rounding and Eligibility
Scores are rounded in the normal manner to an integer (i.e., 30.5 rounds to 31, 30.49999 rounds to
30.0, but only after determining that a score meets the minimum eligibility threshold of at least 20
points. In other words, if a Rurality score is 19.65, it does not round to the minimum eligible score of
20 points.
Shortcuts for the Most Rural Areas
Sometimes you do not need to document each site with Census printouts when the sites are in very
rural areas. For example, imagine a project which has several sites in Wheatland County, Montana.
The applicant could pencil-in the sites on a Census map such as the one below and include a printout
that shows the entire County population to be Census Rural.

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2011 DLT Grant Application Guide

Example of a Fixed Site Rurality Calculation for a Project:
Springfield Hospital proposes to share teleradiology services among itself, two medical centers, and
two clinics. The hospital will be the electronic hub but it is designated a hub/end-user because patients
there will use the services of radiologists from Faryer and Fall City Medical Centers in the absence of
their own. Under the assumption that the benefit to the urban site is incidental to the benefit to the
rural sites, this example project would receive 21 points (105 ÷ 5 = 21) the average of all end-user
sites.
Remember, to be eligible to apply for a grant, the project must score at least 20 Rurality points. In this
case, Faryer, Fall City, and Middleburg are all designated Urban Clusters, but each receives a different
score based on the population of the cluster. The population for the Strinic Clinic is shown as
―<2,500‖ because there is no specific population associated with Census Rural areas.

Site Name (Location)

Site Type

(Same numbering and order as Site & NSLP Worksheets)

(Hub, etc.)

Census
Designation

Census
Rurality
Population Points

Urbanized
Area

56,403

Zero

Hub/EndUser

Urban Cluster

27,298

Zero

3 Fall City Medical Center (Beechwood Urban Cluster)

Hub/End-User

Urban Cluster

12,398

15

4 Middleburg Medical Center (Middleburg Urban Cluster)

End-User

Urban Cluster

2,790

45

5 Strinic Clinic (Windswept Crossroads)

End-User

Census
Rural

<2,500

45

1 Springfield Hospital (Springfield Urbanized Area)

Hub/End-User

2 Faryer Clinic (Faryer Urban Cluster)

Applicant’s Estimated Rurality Score
(Sum of Rurality Points ÷ # of End-User Sites)

59

21

Rurality Score
(For Agency Use)

2011 DLT Grant Application Guide

Rurality Score for Projects in which all End-User Sites are Non-fixed
Important Note - Remember that non-fixed site projects must have an official, geographically defined
service territory based on the map you provided with the Site Worksheet under Tab A of your
application as described on pages 18-19. For example, a visiting nurse association may be chartered to
serve the residents of a specific area. That area may be defined by a political boundary such as a
county. Or it may be defined by a list of zip codes in which they provide service.
What it may not be is a description such as ―well, we sometimes go as far as Mule Corners if we don’t
have other business.‖ Nor can it be a description such as ―well, our map shows a service area, but we
actually don’t serve all of that area.‖ Undefined (flexible) service areas cannot be accurately scored for
Rurality, which makes them ineligible for funding consideration.
Another example of an undefined service territory is any offering that is made generally available over
the Internet. Because the beneficiaries can be anywhere, such projects cannot be accurately scored for
rural benefit (Rurality). While the intent may be to serve rural areas, if the area cannot be accurately
scored because it is geographically undefined, we cannot consider it for funding.
Before you begin, we note that many applicants try to use populations that are more familiar to them
such as townships, boroughs, or zip codes. Use of such population can be done, but we recommend
avoiding this approach because these numbers are frequently misleading and can not be used directly
as described below. Also, as you read this section, you may wish to refer to the Rurality Worksheet-for
Non-Fixed Sites in the Toolkit or the excerpt of that Worksheet that appears several pages below.
Enter each Census Urbanized Area and Urban Cluster in the service territory on a separate line. Show
the name of the Urban Area in column 1, its Census Designation in column 2, and its Census
Population in Column 3. In most cases, the service territory will include all of the Urban Area, and the
same population that is shown in column 3 will be entered in column 4. If the applicant does not serve
the entire Census Urban Area, provide a demonstration of the portion that is in the service territory and
enter that population in column 4. Enter the entire Census Rural population in the service territory on
one line. Rurality Points are based on the size of the Census Urban Area or the Census Rural
Designation as entered in column 3, regardless of whether the applicant serves it in whole or in part.
In other words, if the Urban Area is an Urban Cluster of 15,675, it will be scored as 15 points. If it is
an Urban Cluster of 4,324 or if it is a Census Rural Area, it is scored as 45 points. On each line,
multiply the population shown in column 4 by the points shown in column 5 to obtain the product,
which is entered in column 6. Divide the total of column six by the total of column 4 to obtain the
Rurality Score. Document the Urban Area populations with Census printouts in the manner described
above under fixed sites and as demonstrated in the example that follows. Before reviewing the
example of a non-fixed site project, you may find it useful to review the use of the Census tool as
described above under ―Rurality Score for Projects in which all End-user Sites are Fixed.‖
Example of a Rurality Score for a Non-Fixed Site Project:
Imagine that a visiting nurse association serves Centre County Pennsylvania. As shown below, Center
County (outlined in blue) contains 3 Census Urban Areas: State College Urbanized Area and the
Bellefonte and Philipsburg Urban Clusters. As can be seen below, the Philipsburg cluster straddles the
border with another County. The balance of the County is Census Rural. For purposes of illustration,
we will assume that this organization’s defined service territory includes only Centre County residents.

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2011 DLT Grant Application Guide

Image 12

Image 13
Start by going to the main Fact Finder website as shown above and click on the dropdown menu
―Decennial Census‖ under ―Data Sets.‖ On the next screen, choose ―Detailed Tables.‖ Choose
―County‖ and ―Pennsylvania‖ from the drop down menus as shown below. Wait for the website to
populate the list of counties. Choose ―Centre‖ and then ―add‖ and finally ―show results.‖

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2011 DLT Grant Application Guide

Image 14
The next screen will look like image 10. Choose P1 and P2, ―add,‖ then ―show results.‖ The next
screen shows the total population of Centre County (135,758), the population in Urbanized Areas
(71,301), the population in Urban Clusters (16,021), and the population in Census Rural Areas
(48,436).

Image 15

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2011 DLT Grant Application Guide

With knowledge of its service territory, the applicant can guess that State College is the Urbanized
Area, and that Bellefonte and Philipsburg are the Urban Clusters. To find the size of the Urban Areas,
return to the screen shown in Image 14, select ―Urban Areas,‖ wait for the website to populate the list,
choose ―Bellefonte Urban Cluster,‖ ―add,‖ ―Philipsburg Urban Cluster,‖ add ―State College Urbanized
Area,‖ then ―show results.‖

Image 16
State College accounts for the entire Urbanized Area population in Centre County. The sum of the
Bellefonte and Phillipsburg Urban Clusters (19,978) exceeds the County Urban Cluster Population
(16,021) shown in image 15 by 3,957. By looking at the maps for Bellefonte and Philipsburg, and
recentering throughout the county, it can be determined that that Bellefonte Urban Cluster is entirely
within Centre County, whereas Philipsburg Urban Cluster is partly in Clearfield County. It can also be
determined that there are no other urban clusters in Centre County. Therefore, the portion of the
Phillipsburg Urban Cluster Population within Centre County is 8,737 less 3,957 or 4,780.
The applicant would complete the Rurality Worksheet as shown below. In this case, the hypothetical
project’s score would be 18.35. This project would not be eligible for DLT Grant funding, because the
minimum required Rurality score is 20 points. If the score were eligible, the applicant would attach
the appropriate Census Data Sheets like the ones above as documentation behind a copy of the Rurality
Worksheet – Non-Fixed Sites, which would look as follows:

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2011 DLT Grant Application Guide

1. Service Territory Population Centers
(List each Urbanized Area & Urban Cluster on a separate
line. Show Census Rural Area(s) separately.

3.
2.
4. Population in
5.
Census
Census
Service
Rurality
Designation Population Territory
Points

6. Product
(4 X 5 = 6)

Urbanized
Area

71,301

71,301

Zero

Zero

2 Bellefonte

Urban
Cluster

11,241

11,241

15

168,615

3 Phillipsburg

Urban
Cluster

8,737

4780

30

143,400

4 Centre County Rural

Census
Rural

48,436

48,436

45

2,179,620

1 State College

5
Sum Rows 1-5 of columns 4 & 6 ►
(include any additional rows from continuation sheets)

Applicant’s Estimated Rurality Score
(Sum of Column 6 ÷ Sum of Column 4)

18.35

135,758

2,491,635

Rurality Score
(For Agency Use)

Autonomous Service Territories – We operate under the assumption that a non-fixed site project will
operate over the entire area served by the applicant/organization. In other words, that any grant or
match funded equipment will be used throughout the entire service territory based on, for example,
medical need, not the location of the person to whom the service is provided. As such, the entire
population of the service territory must be used in determining the Rurality score because the entire
population benefits from the grant and/or match.
However, we are aware that in some cases a service provider will have multiple, discrete service
territories that are essentially stand-alone operations. For example, a visiting nurse association may
serve three counties, but operate as three discrete and autonomous units, each providing their service
out of a separate physical facility in one of the three counties and providing service only in that county.
Such an organizational arrangement can be referred to as a regional division.
In cases such, where an applicant serves more than one service territory, and those territories are well
defined, already in existence, and operating autonomously out of a separate physical facility as a
regional division, we can have reasonable confidence that if a grant is awarded to such a regional
division, its benefit will flow only to the residents within that regional division. As a consequence, we
will entertain an application specific to one (or more) regional division(s) of the operation and consider
scoring the application on the specific regional division(s).
The burden of proof will be on the applicant to demonstrate that the equipment and personnel will
work out of an existing physical location separate from other territories served by the organization and
that the division provides service only within that defined territory. Future service territory divisions,
pledges to reorganize by territory, organizational service territories on paper, and other types of
arrangements, that are not distinct and physically autonomous regional divisions will not be
considered. To be considered as stand-alone, the regional division must be existing and genuine.
Otherwise, the applicant must base its scores on the population of the entire service area.

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Supplemental Guidance for Non-Fixed Site Projects:
Complicated Service Territory - Some projects entire service territory may be in an exceptionally
rural area (5,000 or less). If the Pine County visiting nurse association serves all of Pine County, and
the Census website shows no Urban Cluster in the entire County, or no Urban Cluster larger than
5,000, the Rurality Worksheet and supporting data are easily prepared.
On the other hand, a service territory may not be tied to easily identifiable borders like a county. In
such cases, the Census website provides additional levels of detail which should allow evaluation of
even the most complicated service territory by allowing the applicant to align its service boundary with
these smaller population units. The Census provides population information at the County, subCounty and Subbarrio level. It also provides data and maps at the Census Tract, Census Block Group,
and Census Block level. You can obtain these other categories by altering what was done in images 5 7, above. After repositioning on the zip code for State College and choosing ―Change Boundaries and
features,‖ we turn off some things as before but leave Census Tract, Block Group, and Urban Area.
When the map is updated, the Census Tracts and Block Groups are outlined and numbered. If even
finer detail is needed, Census Blocks can be mapped.

Image 17
To obtain the population of Census Tract 115, Block Group 2 (circled on the map above), return to
―Detailed Tables‖ as shown in Image 14, enter the details as shown below, then select ―Add‖ and
―Show Results‖ as in previous examples to obtain the population of that individual Block Group. Note
that this particular tract contains a mixture of urban and rural population:

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2011 DLT Grant Application Guide

Image 18

Image 19
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2011 DLT Grant Application Guide

E-2. National School Lunch Program (NSLP)
This criterion uses National School Lunch Program (NSLP) eligibility statistics as a way to measure
the financial need of the beneficiaries of the DLT project. We ask you to present an estimated NSLP
score in your application. An NSLP Worksheet is provided in the Toolkit for this purpose. The
Agency will review your estimate and correct it if necessary. For purposes of the DLT Program, the
NSLP percentage reflects the percentage of students eligible for reduced-price or free lunches for each
area served by a hub/end-user or end-user site, not the percentage of actual participation.
Background of the NSLP
The NSLP is a federally assisted meal program providing nutritionally balanced, low-cost or free
lunches to millions of children in thousands of schools and childcare institutions. School districts and
independent schools in the program receive cash support and donated commodities from USDA for
each meal they serve. In return, they must serve lunches that meet Federal requirements and they must
offer reduced-price or free lunches to eligible children. The Food and Nutrition Service of USDA
administers the program at the Federal level. At the State level, state education agencies and local
school districts usually administer the NSLP.

The NSLP Score by Type of Project – Fixed and Variable Sites
Most DLT projects operate at fixed sites such as schools or medical facilities. For these traditional
DLT projects, the NSLP score is based on NSLP data for the sites where the end-users are located.
As discussed with greater elaboration above with respect to the Rurality score, other projects serve
end-users that are not fixed but vary over time such as home health care. For these types of projects,
the NSLP score is based on NSLP data for the entire service territory.
Tips:

If you have no supporting data behind your NSLP Worksheet, you have not
documented your NSLP percentages, and you will receive a zero in this
category.
If you are in a small district, where K-12 is in one school, or on one campus where the lunch
facility is shared so that separate NSLP data is not available for the individual high, middle, or
elementary school, make this clear in the supporting documentation you supply behind the
NSLP Worksheet.
If you provide printouts of NSLP data for many schools other than the sites in the application,
please highlight the data relevant to your application.

Determining the NSLP Score for Projects in which all End-user Sites are Fixed
The NSLP score is based on the average of the relevant NSLP eligibility percentage for all hub/enduser and end/user sites. Use the following guidelines in preparing the NSLP Worksheet.

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Does the applicant use specific school or district-wide statistics?
1. If the hub/end-user or end-user site is a public school or non-profit private school of
Kindergarten through Grade 12 (K-12), use the eligibility percentage for that specific school.
If it is a high school, provide high school data. If it is an elementary school, provide data for the
elementary school. Do not provide district-wide data or data from another school.
2. If the hub/end-user or end-user site is any other entity (college, private for-profit school,
library, hospital, clinic, etc.) use the NSLP eligibility score for the public school district in
which the site is located.
How does the applicant enter data on the NSLP Worksheet?
1. Enter each hub, hub/end-user, and end-user site onto the NSLP Worksheet placing them in the
same order as on the Site Worksheet and Rurality Worksheet. Identify the site by type. Provide
data for hubs. Although pure hubs are not part of the calculation, the Agency will need this data
if it determines that the site is actually a hub/end-user. Place pure hubs at the beginning of the
list separated by a space and do not include them in your NSLP calculations as described below.
2. Your sites (fixed-site projects) or service territory (non-fixed-site projects) must be consistent
throughout the application. If the end-user sites or service territory are not consistent, your
application cannot be evaluated and will be returned as ineligible for funding
consideration.
3. Applicants must document each site’s NSLP percentage with a certification from the
organization that administers the NSLP in your area that the data is accurate and the most recent
available. Any site without verifiable documentation attached behind the NSLP Worksheet
will be evaluated at zero percent eligibility. Some official NSLP data is posted on state
and/or local governmental websites. If so, you may provide printouts from these official sites.
Make certain that the official website from which those printout are obtained is provided either
on the printout or is added to it so that we can verify the information. A web address is to be
provided with the printout, but if you provide only a web address, with no data, you have not
documented your data and those sites will be evaluated at zero percent eligibility. Printouts
without evidence of source and data from unofficial sites, such as commercial websites that
report information about schools, are frequently out-of-date and/or unreliable, so they are not
acceptable. Place all NSLP certifications and any other documentation behind the NSLP
Worksheet under Tab E-2 of your application.

NSLP Documentation Errors to Avoid:
1. No documentation. Your application will receive an NSLP score of zero.
2. A statement from the certifying NSLP official that the data is correct and the most recent available,
but with no evidence in the letter of what the data is.
3. An unsigned letter from the certifying official.
4. A letter from the certifying official without a clearly printed name and title.

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How is the score calculated?
1. The ―Average NSLP‖ entered on the NSLP Worksheet is the average of the relevant NSLP
eligibility percentages for all the hub/end-user and end-user sites or, in the case of a non-fixed
site project, all the school districts that serve within the project service territory. When
calculating the average, use the eligibility percentages exactly as received from the source of the
NSLP data. In other words, if the administrator of the lunch program provides data to two
decimal places, enter that data for each site on the NSLP Worksheet to two places.
2. Do not round: After calculating the average, enter it in the ―Average NSLP‖ block on the
Worksheet.
3. Use the decision table below (it also appears on the NSLP Worksheet) to enter the score in the
―Applicant’s Estimated NSLP Score‖ block.
Decision Table
NSLP Percentage:
Points
NSLP < 25%
0
25% ≤ NSLP < 50%
15
50% ≤ NSLP < 75%
25
75% ≤ NSLP
35

Excluded Sites - Your project may benefit urban sites (>20,000) that would not score well in the
Rurality and NSLP Categories. Remember that the DLT Grant Program is intended to benefit rural
sites. We encourage applicants not to include urban end-users in their project. Should you choose to
include urban end-users, but wish to exclude such sites from the calculations, show the excluded sites
separately on the Worksheets with a clear indication that they have been excluded from the
calculations. In such cases, all funds that benefit the excluded sites must come from other funds.
None can be included in the grant or match budget. This is true even if the funds are used for
facilities located at a Hub/End-user site that is included in the Rurality calculation. (See D-1,
Telecommunications System Plan, for detail on apportioning DLT project benefit.)
Example of NSLP Calculation for a Project with Fixed Sites:
Central Community College will link itself, a community library, and two schools to the Deepwoods
Nature Center for the purpose of receiving environmental distance learning courses via teleconference.
The Deepwoods Nature center is the source of the distance learning content and does not receive any
content from the other sites nor will it use equipment placed at Deepwoods to benefit users not shown
on the Worksheet. As such, the applicant considers it a pure hub and does not use it in the calculation.
The applicant correctly provides the NSLP data anyway so that if the Agency finds that the site is an
end-user, it can recalculate the score. Central Community College will be the electronic hub of the
network, but it will receive distance learning content from the Nature Center so it is a hub/end-user.
The average of the four relevant percentages is 36.125%. The applicant looks at the decision table and
enters 15 points in the ―Applicant’s Estimated NSLP Score‖ block.

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2011 DLT Grant Application Guide
Site Name
(Same numbering and order as Site & Rurality Worksheets)

Site Type

(Hub, etc.)

Total
Students

% Eligible
(See
Attached)

1

Deepwoods Nature Center
(school district data)

Hub
Not Incl.

347

37.1

2

Central Community College
(use school district data)

Hub/End-User

3,200

24.2

3

Kingstown Library
(use school district data)

End-user

1,200

28.9

4

Farwell High School
(use specific school data)

End-user

235

34.1

5

Clarksburg High School
(use specific school data)

End-user

432

57.3

Average NSLP

(Sum of NSLP Percentages ÷ # of Sites)
Applicant’s Estimated NSLP Score

(Enter Points from Scoring Table)

36.125%

NSLP Score

15

(for Agency Use)

NSLP Score for Projects in which all End-user Sites are Non-Fixed
The NSLP Worksheet for Non-Fixed Sites is quite similar to that for Fixed Sites except that it
comprises all the Public School Districts that serve the non-fixed site service territory, whether in
whole or in part.
School District Name

Total Students

% Eligible
(See Attached)

1

Valley Falls School District

658

37.67%

2

Great Meadow School District

345

56.82%

3

Sandy Beach School District

532

42.78%

4

Roosevelt Public Schools

439

32.49%

5
Average NSLP

(Sum of NSLP Percentages ÷ # of School Districts
Applicant’s Estimated NSLP Score

(Enter Points from Scoring Table)

70

15

42.44%

NSLP Score

(for Agency Use)

2011 DLT Grant Application Guide

E-3. Leveraging (Matching Funds and other Assistance)
The Leveraging score is based on the eligible matching fund contribution of the applicant and others.
The applicant proposes a match. The Agency determines what is eligible. Based on what you believe
to be eligible, we ask you to present an estimated Leveraging score in your application. The Agency
will correct your estimated score if necessary. This criterion is intended to measure the level of
commitment in the local community for the project. A DLT project that is widely supported within a
rural community is more likely to be strong and successful. Remember that your application is
evaluated for eligibility and scored based on the material submitted by the deadline. Additional
information and clarifications not provided as part of the application as received by the deadline will
not be solicited or considered by the Agency.
Special Matching Provisions for American Samoa, Guam, the Virgin Islands, and the Northern
Mariana Islands. Under Federal law, applications from these areas are exempt from matching
requirements up to $200,000. The maximum DLT Grant in FY 2011 is $500,000 and the required
minimum match is 15%, or $75,000. This means that for the FY 2011 DLT Grant Program, these
areas are not required to provide a minimum match. However, to score points in this category,
applicants from these areas would need to provide the same match levels as other applicants, i.e., a
30% match would yield 15 points.
Eligible purposes for matching funds are identical to eligible purposes for a DLT grant. (Read
this section in conjunction with Section IV, D-1, Telecommunications System Plan & D-2, Budget.) If
an item is not eligible for grant funding, it can not be credited as a match. For a line-item to be eligible
in full for match funding, the application must demonstrate:
1. That none of the use is for ineligible purposes,
2. That none of the use is to benefit sites not shown in the scoring, and
3. That the predominant purpose (over 50% of use) of that line-item is for purposes which
meet the DLT grant definition of distance learning or telemedicine as described in the
application.
If any part of a line-item is for ineligible purposes, the line-item cannot be budgeted for match. If
otherwise eligible but the predominant purpose (50% or more of use) is not for the DLT project, or if
some of the use will benefit sites not shown in the scoring, the applicant can propose that a portion of
the line-item be budgeted for match. The portion eligible for match is that attributable to the sites on
which the project is scored. The balance must come from other funds. (See D-1, Telecommunications
System Plan and Scope of Work, for detail on apportioning DLT project benefit.)
To be eligible, items proposed as match must be integral to the project in exactly the same
way as items the applicant proposes to obtain with the grant. Keep in mind that the DLT
Program is not simply a technology support program. The purpose of matching funds is not to
give an advantage to institutions for general technology purchases that are not part of the
project and which they would have made in any case such as annual computer purchases. It is
intended to build distance learning and/or telemedicine systems by encouraging support for a
project that would not exist if not for the grant.
Your project must have non-Federal matching funds equal to at least 15% of the DLT grant
requested to qualify for the DLT Program. The minimum match receives no points. Matches
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2011 DLT Grant Application Guide

that exceed 15% can earn points on a sliding scale. There are special matching provisions for
American Samoa, Guam, Virgin Islands, and the Northern Mariana Islands. Applications from
these areas are not required to provide a minimum match in order to be eligible for the DLT
Program. However, they must meet the same thresholds (30%, 50%, etc.) in order to earn
points in the Leveraging category.
From time to time, applicants seek to use an existing non-federal grant as matching funds
towards their DLT Grant application. To document the match, they include a copy of the
announcement letter from the grantor. However, the letter from the grantor is often not explicit
about the purpose of the grant or the letter may imply unstated limitations or exclusions. Under
such circumstances, we cannot credit the proposed match. If you intend to apply another grant
as matching funds toward the DLT Grant application, include a letter from the grant recipient
stating that the money in that grant is available and can be applied to the purposes of the DLT
Grant.
Frequently, a complete project requires items that are ineligible as grant or match such as a
building addition. Although not eligible as matching funding, financial support and in-kind
contributions from the local community (other than the applicant) that go toward such items
shows evidence of the commitment of the community to the project. Detail this support in the
Budget and provide evidence of this type of support under F-2, Needs and Benefits, but do not
claim credit for it as a match.
Sources of Eligible Matching Funds:
The Applicant. During this discussion of matching funds, when we speak of the applicant, we
include the formal applicant (the organization that signs the SF-424) and also those entities that
participate in the project as a hub, hub/end-user and or end-user site regardless of whether grant
or match funds are budgeted for that site.
Parties not participating in the DLT project either as a hub, hub/end-user or end-user site or as
manufacturer, vendor, or service provider that will benefit from the grant through the
prospective sale of goods or services. Parties not participating in the project include donors
such as individuals, community groups, state and local governments, and charities. It also
includes businesses whose products or services will not be purchased for the project. In
general, federal funds cannot be used for match. An important exception is funding from the
Appalachian Regional Commission (ARC). Please see www.arc.gov for a list of eligible
counties under the Counties in Appalachia heading. Applying ARC funds as a match requires
coordination with ARC State Program Managers and States in the Region. See the ARC
Members, Partners and Staff link also at www.arc.gov for ARC State Program Managers
contact information. DLT applicants considering an ARC match are strongly encouraged to
contact their ARC State Program Manager(s) early in the process to explore the feasibility of an
ARC grant.
Sources that Cannot Be Considered for Matching Funds
Except for specific exceptions as provided for under Federal law, funds from other Federal
sources cannot be used for matching.
Manufacturers, vendors, and service providers whose equipment or services will be used as part
of the DLT Project.

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Note: The regulation (7 CFR 1703) states that in-kind items must have an ―established monetary
value‖ and that ―manufacturer’s or service provider’s discounts are not considered in-kind
matching.‖ Because the purposes for grant and match are identical, a discount cannot be
considered a cash match either. The reason for not considering discounts is that, in the world of
telecommunications as in many parts of the marketplace, list prices are nominal. They are not an
established monetary value. Actual prices are flexible and it is impossible for us to evaluate
whether a discount has an actual established monetary value. The same logic applies to any
proposed match (cash or in-kind) from a manufacturer, vendor, or other service provider that
stands to benefit from the grant or match funds through the prospective sale of equipment or
services. A match from one of these entities is indistinguishable from a discount and impossible
to evaluate as to its value. As a consequence, we will not accept cash or in-kind matching funds
from manufacturers, vendors, or service providers whose equipment or services will be used in
the project.

Types of Matching Funds:
Cash: The regulation explicitly conveys the expectation that cash will be the usual method of
leveraging when it states that ―matching contributions must generally be in the form of cash.‖ Cash is
unambiguous and can be applied to any eligible item in the budget. During review of an application, if
the Agency were to determine that some items in the budget are ineligible, the removal of those items
would not lower the dollar value of the applicant’s proposed match.
From time to time, applicants characterize their match as ―cash,‖ but specify particular items that they
will acquire with their matching funds. When linked to a specific item, such a proposed match is ―inkind,‖ not cash. As such, the eligibility of the proposed match is directly related to the eligibility of the
item as described in the next paragraph.
In-Kind Match: In-kind matches are also acceptable under the regulation, but we do not recommend
that the applicant propose them. In-kind matches must be closely scrutinized to determine if they have
the same relevance and credibility as a cash match. Remember, an in-kind match must be integral to
and necessary for the DLT project, not simply a technology purchase made in the same timeframe.
Unlike cash, in-kind matches are tied directly to the eligibility of the proposed in-kind item. Should
we determine that the item is not eligible or not integral and necessary for the project, the item
would be removed from the grant and match budget and the proposed match would disappear
with it. This may lead to a lower Leveraging score than you expected to earn. If the reductions were
to lower your eligible match below 15%, your application would be ineligible for the DLT
competition.
As a practical matter, there is no compelling reason for an applicant to propose an in-kind match.
Because items acquired before the application deadline are not eligible for grant or match, any items
that the applicant would propose as an in-kind match must be obtained with cash after the application
is submitted. In other words, when an applicant proposes an in-kind match, it is in effect committing
cash with which the proposed in-kind item will be purchased at some point after the deadline, except
that if the item is not eligible, neither is the match. A true cash match (unspecified) can be applied
against any remaining eligible purpose.

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Proposed in-kind matches from organizations not affiliated with the applicant and whose products or
services will not be purchased as part of the DLT project are acceptable. Remember that the
established monetary value of any proposed in-kind match must be demonstrated through evidence
such as actual selling price. List prices and valuations assigned outside of the marketplace by the
donor or others are not evidence of an established monetary value.
Special Note About In-Kind Matches
Last year we saw a significant increase of in-kind match proposals, no doubt due to pressure on
budgets caused by the economic downturn. The purpose of matching funds in a competition is to
encourage something that would not otherwise occur, not to give an unfair competitive
advantage to entities that routinely make technology purchases over entities that do not. We
scrutinize in-kind matches carefully to ensure they are credible and integral parts of the grant
project. As is discussed above, there is no benefit to the applicant in proposing an in-kind match
unless it is something that the applicant is already planning on purchasing for another purpose, in
which case it is difficult to make the case that the purchase is an integral part of the grant project.
The proposed in-kind matches we see are usually general technology purchases of items we do
not tend to find in applications from those that propose a cash match. They appear to be
compiled by examining planned technology budgets and proposing anything that can possibly be
construed as having some connection to the project. In most cases, we do not credit these
proposed matches because the applicant does not demonstrate that they are a credible and
integral part of the grant project. A ―scavenger hunt‖ approach to matching funds is not a
successful strategy. It creates a large review burden for the Agency and only results in
disappointment for the applicant when they do not gain the Leveraging points they expected to
achieve.
Funding Commitments
Failure to properly document the minimum required match is the single largest reason that an
application is returned as ineligible for funding consideration. For that reason, before we describe how
to document your match, we include this list of errors to avoid.

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TIPS AND MATCH DOCUMENTATION ERRORS TO AVOID
1. Only documented matches will be credited. Each donor, including the applicant, must document its match.
If you have nothing under Tab E-3 in your application, or nothing but a Leveraging Worksheet without
proper documentation behind that Worksheet as described below, you have no match. As a consequence,
your application is ineligible for funding consideration.
2. A signature on the SF-424, Application for Federal Assistance, does not document the commitment of
matching funds in a form satisfactory to the Agency. Neither is a reference to matching funds, say in the
Budget or Telecommunications System Plan. To be eligible, a match must be properly documented by the
donor under Tab E-3.
3. The person signing letters documenting matching funds must have authority to commit funds on behalf of the
donor. If you are not clearly such a person, for example, a chief executive officer, a board chairman, or
school superintendent, you should attach evidence of your ability to commit matching funds. Examples of
titles that do not convey clear authority are ―technical coordinator,‖ ―IT Manager,‖ or ―Radiology
Department Manager.‖
4. An unsigned letter or a letter that does not carry the donor’s title is not acceptable. Neither is a letter that is
signed ―for‖ the responsible party and initialed, unless the person who initialed for the responsible party
provides evidence not only of the responsible party’s authority to commit the organization, but of the
initialing party’s authority to sign on the responsible party’s behalf.
5. You cannot commit funds on behalf of any organization except your own. If you are the superintendent of
XYZ High School, you cannot commit funds on behalf of ABC middle school, a school over which you have
no authority. The commitment for ABC school must come from that organization.
6. Conditional matches are not acceptable. For example, ―We commit ZYX Funds, subject to Board Approval.‖
Until the Board Resolution is passed, no match exists. If it is not passed before the application deadline and
included as part of the application, no proposed match can be credited because the funds were not committed
by that deadline as required under the regulation.
7. Remember that proposed matches must be relevant to the project in the same way as items for which grant
funds are requested. Do not propose as match items that are not going to the project. For example, if the
proposed match is coming from a school district, you cannot be credited for funds going to schools that are
not end-users as shown in the application. If you are proposing an in-kind match, specify the line-items in
your supporting letter by the line-item number shown in the budget.
8. Proposed Matches must be committed and available as of the application deadline. This is true whether
for a pure cash match or for the cash that you have committed as an in-kind match. Matches proposed in
future years are considered conditional and will not be credited. For example, if an applicant proposes $100
per year for ten years, we will credit only the $100 committed in the year of the application. While you may
wish to do internal budgeting over time, a match commitment must be for the entire amount without
conditions.
9. Match letters must be specific and state the dollar amount. Avoid statements like ―We commit 15% of our
need.‖ Instead, state a specific dollar amount such as ―We commit $320 dollars, 15% as much as the grant
budget proposed for our site in the application.‖ If your cash match is intended only for the benefit of a
specific site(s), so state in your letter such as ―We commit $480 dollars, 30% as much as the grant budget
proposed for our site in the application. Should the grant budget for our site be reduced, our proposed match
is also reduced so that it remains 30% of the grant budget for our site in the application.‖

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Match Documentation Specifics - The applicant must document the project’s proposed matching
funds in form and substance satisfactory to the Agency. The documentation must be placed
under Tab E-3 of your application. We have arranged the Leveraging Worksheet to provide a
place to enter each contribution. Each proposed match entry on the worksheet must be
supported by a signed letter from the individual donor proposing the match.
1. Be signed by a person capable of obligating the donor organization. Include the printed name
and title of the person signing the letter. The letter must clearly indicate the name of the donor
organization and state that the funds are committed to the proposed DLT project as described in the
Budget and elsewhere in the application. If your name and title do not appear on the donor
organization’s letterhead, attach evidence of your position to the letter.
2. If the match is cash, state the $ amount. Letters without a stated cash amount cannot be credited
as a cash match.
3. If the proposed match is in-kind, state the $ amount and give a complete description of the
donation identified by the line-item number in the budget and the expected date of purchase.
Letters that do not identify the line-items in the budget cannot be credited as an in-kind match.
Keep in mind that items acquired before the application deadline are not eligible for grant or match.
Also, demonstrate how the established monetary value of the item was determined.
Proposed matches must be consistent on the SF-424, the Budget, and the Leveraging Worksheet.
Proposed matches not documented under Tab E-3 with a letter as described above will not be
credited in the Leveraging score.

Criterion Point Value and Allocation
Up to 35 points are available under this criterion. Points are awarded as follows:
Percentage of Eligible Match Compared to Grant Request
15% < Match % ≤ 30%

Points
0

30% < Match % ≤ 50%

15

50% < Match % ≤ 75%

25

75% < Match % ≤ 100%

30

Match > 100%

35

Example: Applicants receive different scores based on their proposed matching funds:
Applicant #1
Applicant #2
Applicant #3
Applicant #4
Applicant #5

Grant Requested
$100,000
$100,000
$100,000
$100,000
$100,000

Matching Funds
$15,000
$45,000
$60,000
$80,000
$105,000

76

% of GRANT Funds Points Scored
15%
0
45%
15
60%
25
80%
30
105%
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2011 DLT Grant Application Guide

E-4. USDA Empowerment Zones (EZs)
This criterion awards points for an end-user site located in a designated USDA Empowerment Zone
(EZ). (Points are awarded only for Empowerment Zones, not REAP Zones or other USDA
designations.) We ask you to present an estimated EZ score in your application. An EZ Worksheet has
been provided in the Toolkit for this purpose. The Agency will review your estimate and correct it if
necessary.
(Important Note: In prior years, up to 10 points were awarded under this category for sites located in
USDA Empowerment Zones (EZ) and Enterprise Communities (EC) and up to 5 points were awarded
for sites located in Champion Communities (CC). The EZ and EC designations expired in 2009 and
the Champion Community Designation ended in 2010. However, at the end of 2010, the EZ
designation was extended by law until December 31, 2011.)
Up to 10 points may be awarded for this criterion. If your project has:
At Least 1 End-user Site Located in a USDA:

Your Application will Receive

Empowerment Zone

10 points

At the time this document was prepared, these are the 10 USDA Empowerment Zones. You will find
links to each EZ’s page at: www.rurdev.usda.gov/SupportDocuments/BCP-EZECList.doc.
Round 1 Empowerment Zones

Round 2 Empowerment Zones

Round 3 Empowerment Zones

Kentucky Highlands EZ, KY
Mid Delta EZ, MS
Rio Grande Valley EZ, TX

Desert Communities EZ, CA
Southwest Georgia United EZ, GA
Southernmost Illinois Delta EZ, IL
Griggs-Steele EZ, ND
Oglala Sioux Tribe EZ, SD

Aroostook County EZ, ME
FUTURO EZ, TX

If any of your End-user or Hub/End-user sites are located in one of the Empowerment Zones, your
application is eligible for points in this category. Pure Hubs are not eligible for these points. Ten
points can be earned if at least 1 end-user site is in an Empowerment Zone. Additional sites located in
that or another EZ do not earn additional points. The maximum score an applicant can earn in this
category is ten points for having at least one site in an Empowerment Zone.
Any end-user site shown on the EZ Worksheet must be consistent with the sites shown elsewhere in the
application such as on the Rurality and NSLP Worksheets. To document the EZ status of a site, place
printouts from the EZ pages linked to the USDA website shown above behind the Worksheet under
Tab E-4. If not documented under Tab E-4, no points will be awarded in this category.
For further information on Empowerment Zones contact:
USDA Rural Development – Cooperative Programs
1400 Independence Ave. SW Stop 3254
Washington, DC 20250-3254
202-619-7980 or 800-645-4712
http://www.rurdev.usda.gov/BCP-EZEC-Home.html
Email:

sharon.colbert@wdc.usda.gov
or suzette.agans@wdc.usda.gov

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F. Subjective Scoring Supporting Documentation
Subjective Scoring Strategies to Avoid
Over the history of the DLT Program, we have seen three attempted strategies that do not bear fruit for
applicants trying to achieve higher subjective scores. The first is that applicants request copies of
successful applications from prior years to use as a template. The second is that, at the conclusion of
the scoring process, applicants request the scoring team’s comments. The request usually contains
language like ―we want to see where we missed the mark‖ or we want to know what we have to show
to score well.‖ Finally, when applicants appeal their subjective scores, their appeal is often based on a
demonstration that because they addressed each item mentioned in the subjective scoring sections of
the Application Guide, they should get the maximum score.
All of these approaches exhibit a common hunch of applicants that although we describe them as
―subjective‖ scoring categories, we actually have an objective target – that there are specific ways to
respond, or words to use which will score well. Such is not the case. Distance Learning and
Telemedicine projects evolve over time as needs and technology change. They are not a fixed target.
We are looking for the best projects with the most compelling narratives that explain why they are the
best projects. And there is no single ―best.‖ Remember that we are scoring distance learning and
telemedicine projects in the same competition. A better analogy for the DLT subjective category
competition is an art contest in which an applicant can submit a painting, a symphony, a novel, or any
other type of art. There are many approaches to crafting a successful application. That is part of the
reason why as discussed above under Section I-F, Freedom of Information Act, we recommend against
using another applicant’s successful application as a template. That is also why we do not solicit or
collect ―official comments‖ from our scorers. If we did, those comments would become the ―de facto
standard‖ towards which each applicant would aim their narrative and for which they would expect to
earn high scores. Finally, it is why covering each item mentioned in the Application Guide does not
ensure a high score. The advice provided there is not a checklist for a high score, only a starting point.
In the four subjective scoring categories (Additional NSLP, Needs and Benefits, Innovativeness and
Cost Effectiveness), scoring is subjective, not absolute. As the name suggests, subjective scores are
based on the subjective reaction of our scoring teams to the supporting arguments made in the
application. This means that if a project were scored by two teams, it would almost undoubtedly
receive different scores because the process is subjective. That does not mean that one score is correct
and the other incorrect. Not only are these scores subjective, they are relative, in the sense that each
application is scored in comparison to other applications in the competition that year. The competition
varies from year to year and generally gets stronger. Also, the types of projects that applicants seek to
fund change over time as needs and technology change.
The scoring mechanism is intended to create a ranking of projects within these categories. This means,
for example, that an applicant’s score is dependent on the qualities of documentation presented by all
other applicants in that year’s competition. A score received in a prior year for a similar project is not
relevant. Applications tend to improve from year to year, so an applicant who uses the same quality of
documentation year after year can expect to receive progressively lower scores.

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Provide self-contained arguments in each of the four subjective scoring categories. Reviewers will
generally not consider information outside a category’s write-up. For example, all information that the
applicant believes could support its Needs and Benefits score must be under Tab F-2 of the application
to ensure that it will be considered.
Each of the four subjective scoring categories attempts to assess a unique characteristic of the project
which is not captured by the other scoring categories. For example, Needs and Benefits assesses the
specific educational or health care needs, not the general economic needs of a project’s beneficiaries.
Economic need is captured by other scoring categories. Needs and Benefits also does not attempt to
assess the Rurality of a project’s area, although an applicant can argue that an unusual rural
characteristic of its area contributes to its needs in a way that does not affect rural areas in general.
Generally speaking, applicants who apply to the DLT Program are rural and share relatively high
levels of need. For a project to receive a competitive score in this program, the applicant must
successfully demonstrate that it exceeds the norm for rural projects in a particular category.
Applicants are reminded that this is a national competition. Arguments showing only comparisons
with other areas in a state are not compelling in this program. Comparative data should be both local
and national in coverage.
In presentation in each of the four subjective categories, statements supported by numerical data
generally receive the higher scores. Statistics about a project should be compared to national averages
and ranges. These comparisons help reviewers understand statistics presented about a project.
Presenting a spreadsheet showing, for example, statistics about end-user sites, with national references,
is one way to effectively support subjective scoring arguments.
We also note that projects that provide initial benefits will generally score higher in the subjective
categories of Needs & Benefits, Innovativeness, and Cost Effectiveness than those that propose
improvements. For example, in a comparison of two projects with otherwise identical end-users, but
where one is for first-time installation of video-conferencing capability, and the other is for an upgrade
of existing capability, the first-time service will likely earn the higher scores.
Tip: In the subjective categories, do not restrict your supporting documentation to the guidance
and examples cited here or use the examples as a template for your application. The material in
this section is intended only to provide a starting-point. Neither should you think that gaining a
grant requires special language, special expertise, nor that you will be more successful if you
model your application on that of a previously successful applicant. You, the applicant, are the
expert about the needs of your community and how your project will meet those needs. Use that
expertise to paint a compelling picture of what your project can accomplish.

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F-1. Additional NSLP
The primary measure of general economic need for an area served by a proposed project is based on
the National School Lunch Program (NSLP as described above under E-1) and is captured in the NSLP
score. The Additional NSLP category is intended to provide an opportunity for the applicant to
make the case that its NSLP score understates the relative economic need of a project’s
beneficiaries.
If an applicant has an NSLP eligibility below 50%, and the applicant can demonstrate that the area it
would serve, or the subset of the public it would serve, is not accurately captured by the NSLP
percentage, it may request Additional NSLP points. Based on the strength of the evidence provided
by the applicant, the Agency may award up to ten points in this category.
To score well, it is not sufficient to demonstrate, for example, above average unemployment compared
to the state average without putting that statistic into context. The key to scoring points in this
category is providing a convincing demonstration that the economic plight of the applicant’s target
beneficiaries is more challenging that that of other areas with similar NSLP scores.
To gain points in this category, the applicant must specifically request them in Section F-1 of the
Application (See Additional NSLP Worksheet in the Toolkit.).

F-2. Community Needs and Project Benefits
This criterion measures the extent to which the proposed project meets the goals and objectives of the
DLT Program. We may award up to 45 points in this category. You must document the specific
needs of the community and how the proposed project will address those needs. You must also
document evidence of support from the community.
Tip: Remember, this category is not intended to capture the general economic need of the area
served by the project. That need is captured by the NSLP score, and, if applicable, Additional
NSLP scores described above under E-2 and F-1. While a brief overall sketch of the local
economy and geography is useful for context, extended discussions of the overall economic
health of a region generally do not help tell the story of the specific needs to be addressed by
your project.
Discuss Other Projects involving DLT Awards
DLT Grants cannot be awarded to projects that duplicate facilities. If any of the sites or service
territory in the project as described in the application are part of another application in FY 2011 or
were part of a project funded in the previous two DLT competitions (2009 & 2010), explain any
relationship between or among these projects as you discuss the specific need and benefit that will be
provided by the proposed project. In particular, discuss how match and grant funding for this project,
if approved, would complement previous efforts. (Provide a more thorough discussion of project
overlaps in the Telecommunications System Plan, as described above. In the absence of an
explanation, overlaps in projects are assumed to be duplication and as a consequence, proposed grant
and match budget may be adjusted to remove such duplication.)

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In addition, applicants with previous awards should discuss the implementation of that award with
respect to the use of funds. The Agency strives to make the best possible use of DLT Grant Funds.
Previous awardees who are not diligent about using grant funds in a timely manner for their
intended purpose should be aware that this will be considered a negative indication of need when
assigning the Needs & Benefits score.
Define the Community
In some cases, projects propose serving specific communities – the entire population of a town; all
adults in several towns; or students in a particular school district. In others, the community to be
served is a subset of the entire community. Whatever the nature of the community, your narrative
should give us a clear picture of it.
Need for Services
Clearly state the economic, educational, or health care challenges facing the project’s respective
communities, and provide documentation that explains the challenges. Use verifiable data and
statistics to substantiate and quantify these challenges. Demonstrate how the proposed project will
help resolve these challenges and why the applicant cannot afford the project without a grant.
Document support for the project provided by experts in the educational or health care fields.
Remember that the more specific the expert opinion is to your project, the more compelling it is.
Substantiate the underserved educational or health care nature of the project’s proposed service area;
and justify, explain, and document the specific educational or medical services that will provide
direct benefits to rural residents.
You should demonstrate that rural residents and other beneficiaries want the educational or medical
services from the project. In other words, show that the reason for the project is to meet local
community needs, not simply to install technology that could possibly benefit the community.
Willingness of local end-users or community-based organizations to contribute to the costs of
completing, operating, or maintaining the project is a strong indication of community support.
Documentation of support includes letters of financial and non-financial commitment towards the
project from local organizations.
Address the participation by local residents and organizations in planning and developing the project.
Include evidence of this participation in your application. Examples of evidence of community
involvement include community meetings, public forums and surveys.
The Agency will also consider the extent to which the application is consistent with the State strategic
plan prepared by the USDA Rural Development State Director. (See IV-G, Contact With USDA State
Director.)
Benefits Derived from Services
In addition to documenting the need for services, describe how the project would assist the community
in solving these challenges. Document the specific benefits of your project and quantify them in
terms of expected outcomes. Tie the benefits of your project DIRECTLY to the stated needs you
intend to address. Provide measurable targets or goals such as estimates of the number of people that
will benefit from the project.
Tip: Do not address benefits to your organization in this section, unless they are directly
tied to community benefit. Benefits of the project that accrue primarily to your organization
should be addressed under Cost Effectiveness.
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Examples:
For a distance learning project that serves secondary schools, provide the number of schools and
students that will benefit. You should also document all other benefits provided by the project with
quantifiable goals when possible such as:
four-year foreign language availability up from 300 to 1,200 students
organic chemistry offered for first time to entire district
expanded educational facility use, like evening vocational training
reducing the dropout rate from 17% to 12%
For a telemedicine project that serves a consortium of hospitals, provide the number of health care
facilities and the potential number of patients to benefit. You should also document all other
benefits provided by the project such as:
time and monetary savings to the community from telemedicine diagnoses
400 patients receiving at-home monitoring
4 doctors retained in your community
lives saved due to prompt medical diagnosis
Document ancillary benefits or multiple uses that create value in the rural communities which the
project will serve. Examples include training, information resources, library assets, adult education,
lifetime learning, community use of technology, jobs, and connection to the local and global
information networks. If applicable, you should address particular community problems such as outmigration and the extent to which the project would reduce or prevent population loss.

F-3. Innovativeness of the Project
This criterion assesses how the objectives of the proposed project are met in new and creative ways.
Up to 15 points may be awarded for this criterion. There are two obvious ways that a distance
learning or telemedicine project can be innovative, i.e., technical and in application. Technical
innovation is rare but possible in rural distance learning and telemedicine projects. Most of the
innovativeness we encounter is in the application of state-of-the-art technologies to solve problems in
new ways.
Innovation Issues
Technical innovativeness occurs where a new type of device is used to provide a capability. Examples
of innovative technologies are the mobile presentation of a capability that previously had only been
available in fixed locations, or where a new transmission medium (such as the Internet) is used to
deliver data, replacing leased or dial-up telecommunications facilities. We expect applicants to use
state-of-the-art equipment, so doing this alone does not contribute to a high score in this category.
Technical innovativeness can be risky, so wherever it is truly present, the applicant should address any
risks inherent in the approach.
Application innovativeness occurs where a tried and true technology is applied in a unique or unusual
way to provide a new capability, or to provide a familiar capability in a new way. Presumably, all
proposed projects will provide new capabilities to their beneficiaries, so an application with this
characteristic alone would not earn a high score in this category.

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The application should explore the following sources of evidence of innovativeness:
Does the project employ technical innovation?
Are there educational and medical programmatic innovations proposed?
Does the project use unique adaptations of technology to better meet the special needs or
circumstances of the project’s proposed service area or beneficiaries?
Does the project have the potential to influence or promote changes in how distance learning or
telemedicine services can be delivered in other areas?
Does the project use existing resources (telecommunications facilities) in a new way?
Tip: The best examples of innovativeness will come from the imagination of applicants and
cannot be suggested here. Technical and application innovativeness are by no means the only
forms of innovativeness that will be credited by the reviewer.

F-4. Cost Effectiveness of the Project
This criterion evaluates the efficiency with which the proposed project delivers educational and
medical benefits to beneficiaries. Up to 35 points may be awarded for this criterion. Generally,
efficiency of delivery is accomplished by studying every technology option, considering the use of
available resources and using them wherever possible, creating a project that not only accomplishes the
primary service delivery, but accomplishes many other functions as well. The emphasis in this
criterion is value, not lowest cost alone.
Examples of ways the Applicant can demonstrate Cost-Effectiveness include:
1. The extent to which your organization considered alternative technological options for delivering
the proposed services. The applicant must provide sufficient documentation reflecting accepted
analytical and financial methodologies to substantiate its choice of technology as the most cost
effective option. Cost information such as quotations from multiple vendors that you provide in
the TSP and Budget is useful for demonstrating cost effectiveness.
2. The extent to which the project uses existing telecommunications transmission facilities.
Supporting information may include evidence of considerations of the use of existing facilities,
agreements between the applicant and other entities for sharing transmission facilities, and all other
measures taken to lower the project’s costs for using such facilities.
3. The extent to which the project will use existing networks at the regional, statewide, national, or
global levels. Most projects connect to the Internet, so this use of an existing network has a
minimal effect on an application’s score.
4. The extent to which the requested financial assistance will extend or enhance the benefits of the
project.
5. Whether buying or leasing specific equipment is more cost-effective.

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6. Whether a proposed project will accomplish purposes beyond the primary objective. Although the
applicant is asked to specify whether distance learning or telemedicine is the predominant use of
the project, the facilities funded by the project may benefit the community in other ways.
Generally, a multi-use facility will be a greater asset to a rural area than a single-use facility if the
two are equally efficient at performing the project’s primary function.
7. Whether the proposed project creates the appropriate level of capability to reasonably meet the
community’s needs. This refers to a matching of project capability to the defined need.
Tips:
Unsupported assertions of cost effectiveness are not useful. A spreadsheet showing
initial cost and annual costs of all considered alternative technologies and
implementations can offer strong support for a good score in this category. Don’t forget
to explain all assumptions and sources for cost information used in the comparison.
Be sure that the facts presented are meaningful to the reviewer. For example, a statement
that a telemedicine project will provide the capability for 42,000 rural residents to have
access to teleradiology facilities at a cost of 29¢ per resident is not meaningful, but a
statement that the teleradiology project will reduce the cost to a rural resident of a chest
x-ray from $125 to $20, and will save the patient 6 hours of driving time, is meaningful.

G. Contact with USDA State Director
You must provide evidence that your organization has consulted with the USDA State Director for
Rural Development about the availability of other sources of funding available at the State or local
level. Include this evidence as part of your application.
You must also provide evidence from the State Director for Rural Development that your application
conforms with the State strategic plan as prepared under section 381D of the Consolidated Farm and
Rural Development Act (7 U.S.C. 1921 et seq.). Not all states have a strategic plan, so you should
indicate if such a plan does not exist. See Section IV, F-2, Community Needs & Project Benefits, for
our use of this evidence in scoring your application. Include the evidence in your application.
Note: Applicants should contact the USDA State Director as early as possible in
the application process. You can find a listing of the State Rural Development
Offices here:
www.rurdev.usda.gov/recd_map.html

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H. Certifications
The Toolkit contains certification forms to demonstrate compliance with other Federal statutes and
regulations. There are nine required certifications and we have numbered them C-1 through C-9 so
that you can see at a glance if they are all in your application. Applications submitted without a
non-duplication certification cannot be evaluated and will be returned as ineligible.
Important Note: We receive many applications from groups of legal entities that have joined for
the purpose of a DLT Grant application. If your application comes from such a group, and that
group is not eligible to apply as a consortium (See Section IV-B of the Application Guide with
respect to Legal Eligibility), each entity that comprises the group must provide a set of these
certifications. In such cases, the volume of paperwork can be quite large. If the applicant so
chooses, they may provide only one copy of the certifications, which should be included with the
original copy of the application.
C-1
C-2
C-3
C-4
C-5
C-6
C-7
C-8
C-9

Equal Opportunity and Nondiscrimination
Architectural barriers
Flood hazard area precautions
Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970
Drug-free workplace
Debarment and suspension rules
Lobbying for contracts, grants, etc.
Non-duplication of services
Environmental impact

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Section V - Putting it all Together
Assemble and tab your grant application in the following order, which is the same order as
described under Section IV - The Complete Application. Material not located under the proper
tab will not be considered by reviewers. If material is relevant under more than one tab, it
should be repeated under each relevant tab. Any supplemental information that the applicant
wants to submit should be included under the relevant tab. The Toolkit provides forms,
worksheets, sample certifications, and Web resources to help you find information and present it in
your application.
TAB

ITEM

A

SF-424 – Application for Federal Assistance w/attch. (Site Worksheet & Optional Survey)

B

Legal Eligibility

C

Executive Summary

D.

Project Information
D-1 Telecommunications System Plan and Scope of Work
D-2 Budget
D-3 Financial Information and Sustainability
D-4 Statement of Experience

E.

Objective Scoring
E-1 Rurality Calculation Worksheet and Supporting Documentation
E-2 NSLP Worksheet and Supporting Documentation
E-3 Leveraging Worksheet and Evidence of Funding Commitments
E-4 EZ Worksheet and Supporting Documentation (If Applicable)

F.

Subjective Scoring Supporting Documentation
F-1 Request for Additional NSLP Points Worksheet (If Applicable)
F-2 Need for Services and Project Benefits
F-3 Innovativeness of the Project
F-4 Cost-Effectiveness of the Project

G.

Contact with USDA State Director—Rural Development

H.

Certifications

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Process Changes from FYs 2006 & 2007

This appendix repeats discussion of significant process changes as those changes were
described in the Fiscal Year 2006 and 2007 Application Guides.
2006 Application Review Process Changes
Eligibility and Scoring Information to be Complete by Application Deadline
The regulation requires that a ―complete‖ application contain certain information and that it be
submitted by the application deadline. Fundamental information such as that necessary to establish
eligibility to enter the scoring pool and for the scoring itself are expected to be in the original
application. This is confirmed by §1703.129, which concerns an applicant’s right to appeal its score.
In that section it states that an appeal must be based on inaccurate scoring of the application and ―no
new information or data that was not included in the original application will be considered.‖ It
follows that information submitted after the application deadline is not a basis for eligibility or scoring.
To do otherwise gives applicants who do not follow the rules an unfair advantage by allowing them to
demonstrate their eligibility and perfect their score after the deadline. This is not fair to applicants who
submitted a proper application by the deadline according to the rules.
In our continuing effort to make certain that all applications receive fair and equal consideration, all
information necessary for establishing eligibility for the program, for the eligibility of the project, and
for determining the score must be submitted by the application deadline. We will not request such
information after the deadline as part of the completeness review process.
So that there is no ambiguity about what is required by the application deadline, this Application Guide
is cross-referenced so that you will know precisely what to include in your application. The three
thumbnails that follow give a brief description of how applications will be reviewed:
1. Applications whose eligibility cannot be determined because they did not submit information
sufficient to evaluate their project and establish that they meet the minimum set of requirements as
specified in the relevant rules (7 CFR 1703, the 2006 Notice of Solicitation of Applications, and as
elaborated upon throughout this Guide) will be returned as ineligible. In particular, any proposed
match that is not properly documented under Tab E-3 will not be credited. This can reduce the
applicant’s Leveraging score from what they expect. It can also result in the applicant’s being
ineligible for funding consideration because of not meeting the 15% minimum match. Such
applications are ineligible and will be returned to the applicant. See E-3, Leveraging, in Section IV
of the Application Guide for more detail on matching funds and the Leveraging score.)
2. Information not necessary for determining eligibility but necessary for scoring must also submitted
by the application deadline. If scoring information is missing, the application will be scored based
on the information submitted by the deadline.
3. Applications should be complete when submitted. However, information not required under the
previous two paragraphs but necessary in order to be awarded a grant (the information required
under Tabs G and H) will be requested as part of the completeness review process.
Application Format Described in the Application Guide Must Be Followed
The implementing regulation, 7 CFR 1703, is not designed for nor is it intended to be a guide on
how to present your application. That is specified in the Application Guide. In order to make it
administratively possible to review hundreds of applications and make the grant awards within a
reasonable time, all applications must follow the format set in the current year’s Application Guide.
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Process Changes from FYs 2006 & 2007

Applications not presented in this format will be returned as ineligible. In particular, matches not
properly documented under Tab E-3 of your application will not be credited as an eligible match.
Please submit your application in an appropriately sized three-ring binder with tabbed dividers as
described below and throughout the Application Guide. If you submit electronically, make certain that
each page is clearly identified by Tab and page number, as if it were a physical application.
All information relevant to a section must be included under that section. Information contained
elsewhere in the application will not be considered and cannot be a basis for a scoring appeal. For
example, the only information that reviewers will consider in scoring Needs and Benefits is
information which the applicant provides under Tab F-2, Needs and Benefits. If the applicant believes
that information in another section (such as the Telecommunications System Plan) is relevant to the
Needs and Benefits category, the information should be repeated under that category.
Proof of Shipping
Paper applications that are not delivered into our hands by the application deadline must carry proofof-shipping by the application deadline from a third-party shipper such as a commercial carrier or the
postal service. Other indications, such as a printed label from a postage meter, do not constitute proofof-shipping. (Look at C, How to Submit a Paper Application, and D, How to Submit an Electronic
Application, in Section II of the Application Guide for information on submitting your
application.)
Apportioning DLT Project Benefit
Neither grant nor match funds may be used for ineligible purposes. Nor do ineligible purposes become
eligible when they are lumped into a single line-item with eligible purposes. If a line-item will be used
for any ineligible purpose, applicants are advised to obtain vendor pricing that apportions the eligible
and ineligible purposes into separate line-items so that the eligible portion can be considered for grant
or match. Otherwise, the entire line-item is ineligible. Also, to be eligible in full as grant or match, the
applicant must demonstrate, not merely assert, that it will be used at least 50% of the time for purposes
that meet the grant definition of distance learning or telemedicine and must also demonstrate that none
of the other use is for ineligible purposes. Line-items that are used less than 50% of the time will be
eligible as match or grant only for the percentage that does meet the grant definition of distance
learning and telemedicine. See D-1, Telecommunications System Plan & Scope of Work, in Section
IV of the Application Guide for more detail on apportioning DLT project benefit.
Third-Party Procurement
All items to be funded with match or grant must be obtained from an organization other than the
applicant or other entities participating in the applicant’s DLT project as hubs, hub/end-users, or endusers, i.e., items must be procured from a third party. See D, Project Information, in Section IV of
the Application Guide for more detail on third-party procurement.
Matching Funds from Vendors, Manufacturers and Other Interested Parties
We will not accept cash or in-kind matching funds from manufacturers, vendors, or service providers
whose equipment or services will be used in the project. See E-3, Leveraging, in Section IV of the
Application Guide for more detail on matching funds and the Leveraging score.)
In-Kind Matching Funds from Applicant and Participating Sites
The regulation explicitly conveys the expectation that cash will be the usual method of leveraging
when it states that ―matching contributions must generally be in the form of cash.‖ Cash is
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Process Changes from FYs 2006 & 2007

unambiguous and can be applied to any eligible item in the budget. During review of an application, if
the Agency were to determine that some items in the budget are ineligible, the removal of those items
would not lower the dollar value of the applicant’s proposed match.
In-kind matches are also acceptable under the regulation, but we do not recommend that the applicant
or other sites participating in the project propose them. In-kind matches must be closely scrutinized to
determine if they are integral to and necessary for DLT purposes, not simply a technology purchase
made in the same timeframe. Unlike cash, in-kind matches are tied directly to the eligibility of the
proposed in-kind item. Should we determine that the item is not eligible, the item would be removed
from the grant and match budget and the proposed match would disappear with it. This may lead to a
lower Leveraging score than you expected to earn. If the reductions were to lower your eligible match
below 15%, your application would be ineligible for the DLT competition. Please remember that
when you state in your matching documentation or budget that a specific line-item will come
from matching funds, that is a proposed in-kind match, not a cash match. As such, its eligibility
to be credited as a match is tied directly to the eligibility of that line-item.
As a practical matter, there is no compelling reason for an applicant to propose an in-kind match.
Because items acquired before the application deadline are not eligible for grant or match, any items
that the applicant would propose as an in-kind match must be obtained with cash after the application
is submitted. In other words, when an applicant proposes an in-kind match, it is in effect committing
cash with which the proposed in-kind item will be purchased at some point after the deadline.
Applicants should instead propose true cash matches which can be applied against any eligible item in
the budget as a whole. See E-3, Leveraging, in Section IV of the Application Guide for more detail
on matching funds and the Leveraging score.)
Consistent Site Information
DLT Grants are awarded as a result of a competition based on scoring. The nature and location of the
sites and service territory in a DLT project are the basis for that competition. Sites and service
territory must be consistent throughout the application. Otherwise, the application cannot be
properly evaluated as to eligibility or score. Applications without consistent site information will
be returned as ineligible. In particular, the sites must be consistent throughout the application
including the:
1. Standard Form 424, Application for Federal Assistance (Tab A of your application
package). The applicant provides the most detailed site information on the Site Worksheet
as an attachment to the SF-424. The Site Worksheet provides space to respond to
information requested on the SF-424 and is designed to link that information to the project
as described throughout the balance of the application package. The information includes
the precise name and location of the site or service territory. If the applicant wishes to use a
shortened name for a site, the abbreviation must be shown here and that abbreviation must
then be used consistently throughout the application.
2. Telecommunications System Plan (Tab D-1)
3. Budget (Tab D-2)
4. Rurality Worksheet (Tab E-1)
5. NSLP Worksheet (Tab E-2)

2007 Application Review Process Changes

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Process Changes from FYs 2006 & 2007

Refinement of the Tool for Evaluating Rurality
In our continuing effort to ensure fairness in the competition and to simplify the application process,
we have adopted a new tool for use in calculating the Rurality score of a project. As before, the score
will be based on data of the US Census. We will use their objective and extensive urban and rural area
analysis while remaining consistent with the words and intent of the statute and regulation. More
detail is provided below and elsewhere in the Application Guide.
If you are familiar with previous Application Guides, one of the first things you may notice is that this
year’s guide is considerably longer. This is due almost entirely to the additional guidance we have
provided about how to use the Census website for determining your Rurality Score. This guidance
contains many images of the relevant portion of Census web pages highlighting the navigational
techniques needed to gain access to the data.
Background - The DLT program was created and operates under three pieces of legislation – the Farm
Bill of 1990, an Amendment to the Farm Bill of 1992, and the Farm Bill of 1996. The program was
conceived in the first of these bills, implemented in the second, and had features added to it in the
third.
The statutory authority directs the Agency to finance ―the construction of facilities and systems to
provide telemedicine services and distance learning services in rural areas,‖ but leaves the
determination of ―rural areas‖ largely to the Agency, which is instructed to consider the ―population
sparsity of the affected rural area.‖
Without new guidance in the legislation, the Agency adapted the definition of ―rural‖ from the Rural
Electrification Act under which we have operated our Telecommunications Program since 1949 and
the Electric Program since 1935. As guided by the ―sparsity‖ language and other guidance in the
statute, we set an ―urban‖ threshold of over 20,000 and divided populations under 20,000 into scoring
ranges.
We repeat the DLT regulatory definition here for ease of reference:
EXCEPTIONALLY RURAL AREA – 5000 and under. Any area of the United States not
included within the boundaries of any incorporated or unincorporated city, village, or borough
having a population in excess of 5,000 inhabitants. (45 points)
RURAL AREA – 5,001-10,000. Any area of the United States included within the boundaries of
any incorporated or unincorporated city, village, or borough having a population over 5,000 and
not in excess of 10,000 inhabitants. (30 Points)
MID-RURAL AREA – 10,001-20,000. Any area of the United States included within the
boundaries of any incorporated or unincorporated city, village, or borough having a population
over 10,000 and not in excess of 20,000 inhabitants. (15 Points)
URBAN AREA - Over 20,000. Any area of the United States included within the boundaries
of any incorporated or unincorporated city, village, or borough having a population in excess of
20,000 inhabitants. (Zero Points)

In short, the lower the population, the more points are scored. Clearly, the regulatory intent is to target
program benefit to the most rural (sparsest) areas by giving those areas the highest score.
As the awareness of the DLT Program has spread through the education and medical communities and
from its intended rural constituency to suburban and urban America, we have been receiving more
applications to serve areas that no observer would characterize as ―rural,‖ but if scored on the
individual city, village, or borough jurisdictions, would receive a higher score than if the entire
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Process Changes from FYs 2006 & 2007

population center were considered. This is because the larger urban population is often divided into a
number of separate jurisdictions whose individual populations may each be a small percentage of the
overall urban population.
To ensure accuracy in a competitively scored program aimed at sparsely settled areas, the tools used to
evaluate ―rural‖ and ―urban‖ should lead to a genuine characterization of how rural an area is. In other
words, given two otherwise identical population centers, they should be scored similarly. The score
should not be the result of varying jurisdictional peculiarities.
Analysis - There are two striking characteristics of the definition that must be considered in refining
the scoring tool:
1. The language in the regulation refers to ―any incorporated or unincorporated city, village, or
borough‖ having a certain population. Because an ―unincorporated city, village, or borough‖ has no
defined boundaries or even a legal existence, the definition can be construed as referring to a
collection of people in a population center that has characteristics typical of population centers such
as cities, villages, and boroughs. In other words, in a state where towns are often not incorporated,
a collection of 700 people living around a crossroads could be considered an unincorporated village.
In another state, several adjacent boroughs that share the population characteristics of a city could
be considered an unincorporated city.
The jurisdictional nature of population centers varies greatly from state to state. Townships, which
are not mentioned in the regulation, are borough-like entities in some states. In others, a borough
does not even describe a population center. A borough in Alaska is more like a county. Using a
borough population would greatly overstate the population of a specific end-user site located
outside of any town but within an Alaskan borough. Similarly, some cities have limits that extend
far beyond the Urban Area and include significant rural area(s). Sites in the rural area, but within
the city limits, would be scored inaccurately if based on the population inside the city limits.
Otherwise identical collections of people are organized politically in many different ways across the
country. It is clear that using population data only from individual incorporated cities, villages, and
boroughs provides non-uniform and unfair outcomes in the Rurality scoring category between
projects and among states. Complicating this, prior to this year, we had not found a satisfactory tool
for evaluating the population of an ―unincorporated city, village, or borough‖ that is accurate,
objective, and publicly available at no cost to applicants.
2. The word ―boundaries‖ is plural. This suggests that we consider not only the individual boundary
of each city, village, or borough, but the collective boundaries should such jurisdictions be part of
one population center. It also directs us to consider the de facto boundaries of similarly populated
unincorporated areas.
There is a compelling reason for looking at urban populations as a whole rather than by jurisdiction.
As noted above, in some states, areas that have large populations are divided into multiple adjacent
jurisdictions. Such individual jurisdictions within a larger population do not look or feel rural in the
way that an isolated jurisdiction with a similar population does and they do not share the isolated
community’s challenges that flow from an overall low population.
Conclusion - Similar populations should produce similar scores. We believe we must use an
objective, nationally consistent, and publicly available (at no cost to applicants) tool to evaluate
Rurality and that we have found that tool in the extensive data and objective analysis of the
Department of Commerce’s US Census. The Census defines Urban Areas by the collective urban
characteristics of a population center independent of political jurisdictions. We know of no other
objective measure that is free and easily available to the public that comes closer to capturing the intent
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Process Changes from FYs 2006 & 2007

of the statutory direction to consider the ―population sparsity of the affected rural area‖ while
remaining consistent with the words and intent of the DLT regulation.
Census Designated Urban Areas - The Census defines two sizes of Urban Area:
1. Urbanized Area (UA) - An Urbanized Area is a statistical geographic entity comprising a
central core and adjacent densely settled territory that together contain at least 50,000
people, generally with an overall population density of at least 1,000 people per square
mile. An Urbanized Area can include all or part of one or more city, village, or borough as
well as adjacent areas not incorporated as a city, village, or borough. An Urbanized Area
does not share any area with another Urbanized Area or Urban Cluster. To learn more
about Census geography, terms and criteria see www.census.gov/geo/www.
2. Urban Cluster (UC) - An Urban Cluster is a new statistical geographic entity designated
for the 2000 Census, consisting of a central core and adjacent densely settled territory that
together contains between 2,500 and 49,999 people. Typically, the overall population
density is at least 1,000 people per square mile. Urban Clusters are based on Census block
and block group density and do not coincide with official municipal boundaries. An Urban
Cluster can include all or parts of one or more city, village, or borough as well as adjacent
areas not incorporated as a city, village, or borough. An Urban Cluster does not share any
area with, or touch another Urbanized Area or Urban Cluster.
The example that follows is for illustration. Guidance on how to use the website from which this
Census Data is obtained is provided under E-1, Rurality, in Section IV of this guide. In addition to
population data, the Census site has a wealth of information, including mapping of school and
Congressional Districts, which can be of assistance in completing the Site Worksheet attachment to the
Standard Form 424, Application for Federal Assistance.
Example: Lincoln Park is a Census-designated place in Colorado. Here is how its population and area
(in yellow) are displayed on Fact Finder if you use the ―fast access to information‖ lookup on its main
page (factfinder.census.gov/home/saff/main.html?_lang=en).

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Process Changes from FYs 2006 & 2007

Lincoln Park’s population is given by Fact Finder as 3,904, but if you click on ―reference map,‖ it is
clearly part of the greater Canon City population center. A site located in Lincoln Park, immediately
adjacent to the Canon City population of 15,431 is not as rural as one located in an isolated town of
4,000. It does not share the reduced access to goods, opportunities, and services, particularly
telecommunications, typical of the more thinly populated isolated town.

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Process Changes from FYs 2006 & 2007

However, even adding Lincoln Park to Canon City doesn’t capture the actual size of the population
center. The total population, as determined by the Census’ Urban Cluster analysis, comprises Canon
City, Lincoln Park, and parts of other adjacent places for a total in the contiguous built-up Urban Area
of 26,332.

If a site is located in Lincoln Park, the Canon City Urban Cluster population is a better indicator of
Rurality than is Lincoln Park’s individual jurisdictional population. The situation is similar in many
major metropolitan areas. Highland Park is an independent city in Texas with a population of 8,842.
But it is surrounded by the City of Dallas, and is an integrated piece of the Dallas-Fort Worth
Urbanized Area, which the Census shows as having a population of 4,145,659. Clearly, the Census’
Urbanized Area population gives a more accurate picture of whether a site in Highland Park is located
in an urban or rural area.
Throughout this guide, we will use population data from Census designated Urbanized
Areas (≥50,000), Urban Clusters (2,500-49,999), and Census Rural (<2500) as the tool for
determining populations located “within the boundaries of an incorporated or
unincorporated city, village, or borough.” Guidance for completing your Rurality
Worksheet and for finding population data are provided in this guide under E-1, Rurality,
in Section IV of the FY 2007 Application Guide.
Rurality and NSLP Scoring for Applicants with Non-Fixed End-User Sites
Applicant eligibility and scoring, particularly with respect to the Rurality category, is based on the
location of the specific end-user sites such as schools or rural health clinics where people will benefit
from the distance learning or telemedicine project. In recent years, we have received increasing
numbers of applications from projects in which the end-user sites are not fixed. An example of this is
a home health monitoring project where the equipment is moved over time from one patient’s home to
another as medical needs arise. Another example is an ambulance-based telemedicine project, where
the equipment will serve an entire area.
These types of projects were not contemplated when the regulation was adopted. As a consequence,
there is no established method for the applicant to estimate and for us to evaluate such an applicant’s
Rurality score or its NSLP score. Rurality, in particular, is central to the process because it is
important not only in scoring, but in determining if the applicant is eligible for the program.
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Process Changes from FYs 2006 & 2007

Because these types of projects are becoming more common, we must specify a fair scoring method
that meets the spirit of the regulation while providing a measure of rural benefit that is reasonably
comparable to that captured by the method for fixed-site projects. We have provided such a method in
this Application Guide. Applicants for such projects will base their Rurality calculation on the total
population within their service territory that is located in each population zone using the Urban Area
and Rural designations of the US Census as described above and under E-1, Rurality, in Section IV of
this guide. In other words, each person, or potential end-user, is treated as if it were an actual end-user.
Because this method will not look at specific sites but on the population as a whole, such applicants
will base their NSLP calculations on the average for all school districts in the service territory. Also,
because we must be able to evaluate the population that benefits from the project, the applicant must
have a defined service territory (and end-users) that can be definitively shown on a map. Projects to
serve undefined users (fixed sites or not) cannot be evaluated or scored, which makes them ineligible
for the competition.
Finally, an application must be exclusively for one or the other, either fixed or non-fixed sites. The
service areas of fixed and non-fixed site projects are not directly comparable because they are unlikely
to benefit the same universe of people. As a consequence, we have no administratively practical way
to score an application that contains both types of projects. An example would be an application for a
fixed site teleradiology project that connects four clinics operated by technicians with the radiology
department of a hospital as well as a non-fixed site project such as placing a videoconferencing system
connecting an ambulance to the emergency room for purposes of triage. In other words, if you have
both components in your plans, and you include both in one application, we cannot evaluate or score it,
which will result in its being ineligible. See E-1, Rurality, and E-2, NSLP, for more detail about
developing the Rurality and NSLP data and scores for projects with non-fixed end-user sites.
New Worksheets
In an effort to make certain that applicants know exactly what to submit and that it is submitted in a
form that will speed the grant award process, we modified several worksheets in the DLT Grants
Toolkit in FY 2006. This year we have added Site, Rurality, and NSLP Worksheets specifically
designed for projects with non-fixed end-user sites as described in the preceding paragraphs.
We stress that all the Worksheets are there to guide you through the process and will prevent
your making errors in the application. For example, the Leveraging Worksheet reminds you to
document each donation in your proposed match under Tab E-3 behind that Worksheet. If you do not
do so, the undocumented matches can not be credited, which could result in your application’s being
ineligible. (See the Toolkit for all the worksheets and forms you need to complete your application.)

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Distance Learning & Telemedicine Program

FY 2011 Grant Program

Toolkit
Rural Utilities Service
Rural Development
United States Department of Agriculture

Contents
Page

Application Resources & Tips
SF 424—Application for Federal Assistance
SF 424 Instructions (Combined OMB and RD Instructions)
Survey on Ensuring Equal Opportunity for all Applicants
Budget:
Overall Budget Worksheet
In-Kind Match Worksheet
Other Funds Worksheet

T-ii
T-1
T-3
T-7

T-9
T-11
T-12

Fixed Site Applications Use:
Site Worksheet – Fixed Sites
Rurality Worksheet – Fixed Sites
NSLP Worksheet – Fixed Sites

T-13
T-15
T-17

Non-Fixed Site Applications Use:
Site Worksheet – Non-Fixed Sites
Rurality Worksheet – Non-Fixed Sites
NSLP Worksheet – Non-Fixed Sites

T-19
T-21
T-23
T-25

Leveraging Worksheet
EZ Worksheet
Additional NSLP Worksheet

T-26
T-27

Certifications
Equal Opportunity and Nondiscrimination
Architectural Barriers
Flood Hazard Area Precautions
Uniform Relocation Assistance & Real Property Acquisition Policies Act
Drug-Free Workplace
Debarment, Suspension, and Other Responsibility Matters
Lobbying for Contracts, Grants, Loans, and Cooperative Agreements
Non Duplication of Services
Environmental Impact
T-i

C-1
C-2
C-3
C-4
C-5
C-6
C-7
C-8
C-9

Application Resources & Tips
APPLICATION GUIDE: Please read and follow the Distance Learning and Telemedicine
Program FY 2011 Grant Application Guide as you fill out the forms, worksheets and
certifications in this Toolkit.
AS YOU FILL OUT OR SIGN EACH OF THE TOOLKIT ITEMS, place them under the tabs of your
grant application as explained in Section V, “Putting It All Together,” of the Grant
Application Guide.
FILL THE FORMS OUT COMPLETELY. Missing or inaccurate data on ANY of the forms will
adversely affect our ability to process your application.
REGULATIONS: The Program’s regulation governs the application process, the Guide and
this Toolkit, but it does not specify application format. Use the FY 2011 Application Guide
for instructions on how to prepare your complete application package. (See the Code of
Federal Regulations, 7 CFR 1703, Subparts D, E, F and G. A copy of the regulations is
posted at the DLT Web page listed below.)
CATALOG OF FEDERAL DOMESTIC ASSISTANCE (CFDA) Number: 10.855
DLT PROGRAM:

(202) 720-0413

dltinfo@wdc.usda.gov

ONLINE RESOURCES
DLT Resources Web page
RUS Staff including
Advanced Service Division
and General Field
Representatives
USDA Rural Development
State Directors

http://www.rurdev.usda.gov/UTP_DLTResources.html

EZ Webpage

http://www.rurdev.usda.gov/SupportDocuments/BCP-EZECList.doc

ARC Resources

www.arc.gov

State Single Points of
Contact (SPOC)

http://www.whitehouse.gov/omb/grants_spoc

Grants.gov Information

http://www.grants.gov/

Get a DUNs Number

http://www.grants.gov/applicants/request_duns_number.jsp

Census FactFinder

http://factfinder.census.gov/home/saff/main.html?_lang=en

http://www.rurdev.usda.gov/UTP_ContactStaff.html

http://www.rurdev.usda.gov/StateOfficeAddresses.html

T-ii

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0575-0096. The time
required to complete this information collection is estimated to average 49 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

T-iii

Reproduction of OMB Number: 4040-004
Expiration Date: 1/31/2009

Application for Federal Assistance SF-424 (page 1 of OMB’s webpage version)
1. Type of Submission:

2. Type of Application

√

Preapplication

√ Application

New

3. Date Received:

* If revision, select appropriate letter(s)

_____________________________________

Continuation

Changed Corrected Application

Version 02

* Other (Specify)

Revision ______________________________________
4. Applicant Identifier:

5a. Federal Entity Identifier

* 5b. Federal Award Identifier:
_______________________________

___________________________.

6. Date Received by State: __________________________________

7. State Application Identifier.___________________________

State Use Only

8. Applicant Information:
a. Legal Name: __________________________________________________________________________________________________________
b. Employer/Taxpayer Identification Number (EIN/TIN)
____________________________________________

c. Organizational DUNS:
_________________________________________________

d. Address:
* Street 1: _____________________________________________________________________________________________________________
Street 2: _____________________________________________________________________________________________________________
* City:

______________________________________________________________________________________________________________

County: ______________________________________________________________________________________________________________
* State:

_____________________________________________________________________________________________________________

Province: _____________________________________________________________________________________________________________
* Country: _____________________________________________________________________________________________________________
* Zip/Postal Code: _________________________
e. Organizational Unit
Department Name: ________________________________________

Division Name: ____________________________________________

f. Name and contact information for matters involving this application:
Prefix: _________________________ *First Name _______________________________________________________
Middle name: ______________________________________________________________________________________
*Last Name: _______________________________________________________________________________________
Suffix: __________________________
Title:______________________________________________________________________________________________
Organizational Affiliation_______________________________________________________________________________
Telephone Number: ______________________________

Fax Number: ___________________________________

E-mail: ________________________________________________________________

T-1

Application for Federal Assistance SF-424 (pages 2 and 3 of OMB’s webpage version)

Version 02

9, Type of Applicant: #1 ______________________________________
#2 ______________________________________
#3 ______________________________________
Other (Specify)_______________________________________________________________________________
10. Name of Federal Agency: Rural Development Telecommunications Program
11. Catalog of Federal Assistance Number: 10-855
CFDA Title: Distance Learning and Telemedicine Loans and Grants
12. Funding Opportunity Number: RDUP-07-01-DLT
Title: USDA-DLT
13. Competition Identification Number: Leave Blank
Title: Leave Blank
14. Areas affected by Project:

Attach Site Worksheet

15. Descriptive title of Applicant’s Project:

______________________________________________________________________________

Attach supporting documentation as specified in agency instructions:

Attach Site Worksheet. Assemble and Tab Completed Application Package as described in Application Guide
16. Congressional Districts of:
17. Proposed Project:

a. Applicant: ___________b. Program/Project: _______________

a. Start Date: _____________________________

18. Estimated Funding:
a. Federal:

___________________________________

b. Applicant:

___________________________________
a. This application was made available
to the State under the E.O.
12372 process for review on:
_______________________

d. Local leave blank
___________________________________

b. Program is subject to E.O. 12372, but not selected by the State.

f. Program Income: leave blank
g. Total

b. End Date:___________________________________

19. Is Application Subject to Review by State under
Executive Order 12372 Process?

c. State: leave blank
e. Other

Attach Site Worksheet

___________________________________

20. Is the Applicant delinquent on any Federal Debt?

NO

c. Program is not covered by E. O. 12372.

YES (If yes, provide and attach an explanation).

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 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: ______________________________________ Fax Number: __________________________________________
e-mail: _________________________________________________________________________________
Signature of Authorized Representative: ________________________________________________ Date: ______________________
Authorized for Local Reproduction

Reproduction of Standard Form 424 (Revised 10/2005)
Prescribed by OMB Circular A-102

T-2

INSTRUCTIONS FOR THE SF-424

These instruction include general instructions provided by OMB (in black) and the additional instructions and
guidance from the Agency (in blue). In many cases, the Agency provides specific instructions or has already
filled in the information making the general OMB instruction less useful. For these, the OMB text is shown in a
small font. General OMB Directions not applicable to the DLT Program are struck through. This is a standard form
(including the continuation sheet) required for use as a cover sheet for submission of preapplications and applications and related information under discretionary
programs. Some of the items are required and some are optional at the discretion of the applicant or the Federal agency (agency). Required items are identified with an
asterisk on the form and are specified in the instructions below. In addition to the instructions provided below, applicants must consult agency instructions to determine
specific requirements. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO
THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

1. We have already checked the “application box” for you.

1. Type of Submission: (Required): Select one type of submission in
accordance with agency instructions. • Preapplication • Application • Changed/Corrected Application – If requested by the agency, check if this submission is to
change or correct a previously submitted application. Unless requested by the agency, applicants may not use this to submit changes after the closing date.

2. We have already checked the “new” box for you.

Type of Application: (Required) Select one type of application in accordance with
agency instructions. New – An application that is being submitted to an agency for the first time. Continuation - An extension for an additional funding/budget period
for a project with a projected completion date. This can include renewal. Revision - Any change in the Federal Government’s financial obligation or contingent
liability from an existing obligation. If a revision, enter the appropriate letter(s). More than one may be selected. If "Other" is selected, please specify in text box
provided. A. Increase Award B. Decrease Award C. Increase Duration D. Decrease Duration E. Other (specify).

3-5. Leave blank for our use.

3. Date Received: Leave this field blank. This date will be assigned by the Federal agency. 4. Applicant Identifier: Enter
the entity identifier assigned by the Federal agency, if any, or the applicant’s control number if applicable. 5a. Federal Entity Identifier: Enter the number assigned to
your organization by the Federal Agency, if any. 5b. Federal Award Identifier: For new applications leave blank. For a continuation or revision to an existing award,
enter the previously assigned Federal award identifier number. If a changed/corrected application, enter the Federal Identifier in accordance with agency instructions.

6-7. Leave blank for state use.

6. Date Received by State: Leave this field blank. This date will be assigned by the State, if applicable. 7. State
Application Identifier: Leave this field blank. This identifier will be assigned by the State, if applicable.

8. There are multiple entries in this block.
a. Enter the legal name of the applicant that will undertake the project funded by the assistance as that name
appears in legal documents such as contracts, i.e., in full without abbreviations or omissions. (See Section
IV-B of the Application Guide.) Applicant Information: Enter the following in accordance with agency instructions: a. Legal Name: (Required):
Enter the legal name of applicant that will undertake the assistance activity. This is the organization that has registered with the Central Contractor Registry.
Information on registering with CCR may be obtained by visiting the Grants.gov website.

b. Enter the employer or tax identification number assigned by the IRS.

If your organization is not in the US, enter 44-4444444.

c. OMB requires all grant applicants supply a DUNS Number (Dun & Bradstreet Universal Numbering
System). The number is free. To obtain a DUNS number, please call Dun & Bradstreet at 866-705-5711 or
refer to www.whitehouse.gov/omb/grants/duns_num_guide.pdf. c. Organizational DUNS: (Required) Enter the organization’s DUNS or
DUNS+4 number received from Dun and Bradstreet. Information on obtaining a DUNS number may be obtained by visiting the Grants.gov website.

d. Enter the complete address as follows: Street address (Line 1 required), City (Required), County, State (Required, if
country is US), Province, Country (Required), Zip/Postal Code (Required, if country is US).
e. Enter the name of the primary organizational unit (and department or division, (if applicable) that will undertake the
assistance activity, if applicable.

f. This information will be used for all contact and correspondence. Please complete carefully and in full.
Attach a sheet if you want to provide additional contacts. It is crucial that we have accurate information, in
particular, a fax number. If you do not have a fax, you must provide a reliable e-mail address to receive
correspondence promptly. Otherwise, it will go by regular US mail. Given that response deadlines are based
on the date of our correspondence, using mail effectively shortens your time to respond. If any of you contact
information changes after you submit your application, please inform us.
If you wish to delegate someone not in your organization to act on your behalf, attach a letter to the SF
424 listing the person’s name, organization, contact info, and relationship to your organization. Make sure the
letter states the scope of the delegation and any time limit you wish to apply to their authority. The letter of
delegation must be signed by the same authorized person who signs the SF 424 in Block 21. Remember, if
you delegate someone, that person is responsible for responding to any date-sensitive request from us. Faxes
T-3

(or e-mails) will be sent to that contact. We also send a copy to the applicant, but that correspondence goes by
mail. If you designate someone to act, but also wish to receive such correspondence as promptly as possible,
make that clear and provide contact info for both. Name (required), organizational affiliation (if affiliated with another organization than the
applicant organization, enter the name (First and last name), telephone number (Required), fax number, and email address (Required) of the person to contact on matters related
to this application.

9. Type of Applicant: (Required) Select up to three applicant type(s) in accordance with agency instructions.
For example, a public university that if identified as an Historically Black College could enter “H,T” Use the
following designations. Many are self-explanatory.
A. State Government. Do not include state supported institutions of higher learning.
B. County Government. Exclude supported institutions of primary, secondary, or post secondary learning.
C. City or Township Government. Also include boroughs or other forms of local municipal government.
Exclude supported institutions of higher learning or post secondary education.
D. Special District Government. According to the Census, special district governments are independent,
special purpose governmental units that exist as separate entities with substantial administrative and fiscal
independence from general purpose governments. This excludes school district governments. Special
district governments provide specific services, usually only one, not supplied by general purpose
governments. The services range from hospitals and fire protection to mosquito abatement and cemetery
upkeep. It covers a wide variety of entities, most of which are officially called districts or authorities.
However, not all so named represent separate governments. Many “districts” or “authorities” are so
closely related to county, municipal, or state governments that they are classified as subordinate agencies
of those governments. In order to be considered a special district government, an entity must possess
three attributes - existence as an organized entity, governmental character, and substantial autonomy.
E. Regional Organization. An organization affiliated with more than one state or local government, but
without the governmental character of a Special District Government.
F. U.S. Territory or Possession.
G. Independent School District. Includes public primary & secondary districts (K-12), regardless of their
specific relationship to states, counties, municipalities, or overlap with other public school districts.
H. Public/State Controlled Institution of Higher Learning
I. Indian/Native American Tribal Government – Federally Recognized
J. Indian/Native American Tribal Government – Other than Federally Recognized.
K. Indian/Native American Tribally Designated Organization.
L. Public Housing Authority/Indian/Native American Housing Authority.
M. Nonprofit (Secular) with 501C3 IRS Status (Other than Institution of Higher Education.)
N. Nonprofit (Secular) without 501C3 IRS Status (Other than Institution of Higher Education.)
O. Private Institution of Higher Education.
P. Individual. Individuals are not eligible for the DLT Grant Program.
Q. For-Profit Organization other than Small Business.
R. Small Business
S. Hispanic-Serving Institution.
T. Historically Black Colleges and Universities (HBCUs).
U. Tribally Controlled Colleges and Universities (TCCUs).
V. Alaska Native and Native Hawaiian Serving Institutions.
W. Non-domestic (non-US) Entity. Not eligible. Only domestic areas (US and certain territories) qualify for
DLT Funding.
X. Other. (specify)
Y. Nonprofit. (Faith-Based – with or without 501C3 IRS Status)
T-4

10-13. We have entered the required information in blocks 10-12. Leave Block 13 blank.

10. (Required) Enter the name
of the Federal agency from which assistance is being requested with this application. 11. Enter the Catalog of Federal Domestic Assistance number and title of the
program under which assistance is requested, as found in the program announcement, if applicable. 12. (Required) Enter the Funding Opportunity Number and title of
the opportunity under which assistance is requested, as found in the program announcement. 13. Enter the Competition Identification Number and title of the
competition under which assistance is requested, if applicable.

14-16. The information requested in these blocks is placed on the appropriate Site Worksheet. You may enter a
descriptive title in block 15. Most applications propose projects that operate at fixed sites such as schools or
medical clinics. Other projects operate at non-fixed sites. Examples of the latter include visiting nurse
associations and ambulance-based systems. To be eligible, projects must be exclusively one or the other.
Depending on the type of project, applicants will complete either the Fixed Site Worksheet or the Non-Fixed
Site Worksheet. Remember that an application cannot be evaluated or scored (which makes it ineligible) if it
contains both a fixed and non-fixed site component. See A., “Standard Form 424 and Attachments,” and D-1,
“Telecommunications System Plan,” in Section IV of the Application Guide for extended discussion of how to
categorize sites in your application and for determining which worksheet you should complete. 14. List the areas or
entities using the categories (e.g., cities, counties, states, etc.) specified in agency instructions. Use the continuation sheet to enter additional areas, if needed. 15.
(Required) Enter a brief descriptive title of the project. If appropriate, attach a map showing project location (e.g., construction or real property projects). For
preapplications, attach a summary description of the project. 16. (Required) 16a. Enter the applicant’s Congressional District, and 16b. Enter all District(s) affected by
the program or project. Enter in the format: 2 characters State Abbreviation – 3 characters District Number, e.g., CA-005 for California 5th district, CA- 012 for
California 12th district, NC-103 for North Carolina’s 103rd district. • If all congressional districts in a state are affected, enter “all” for the district number, e.g., MD-all
for all congressional districts in Maryland. • If nationwide, i.e. all districts within all states are affected, enter US-all. • If the program/project is outside the US, enter 00000.

17. (Required) Enter the proposed start date and end date of the project.
18. (Estimated Funding): Data shown in this box is summary information only. Showing a match in Box 18-b
does not constitute documentation of matching funds in form and substance satisfactory to the Agency for
evaluating matching funds. You must document your matching funds under Tab E-3 – Leveraging. (Required) Enter
the amount requested or to be contributed during the first funding/budget period by each contributor. Value of in-kind contributions should be included on appropriate
lines, as applicable. If the action will result in a dollar change to an existing award, indicate only the amount of the change. For decreases, enclose the amounts in
parentheses.

a. Federal: Show the amount requested from the Agency as a grant. This number is line E, DLT GRANT
REQUEST, in the Budget Summary block at the bottom of the Overall Budget Worksheet (See Toolkit).
b. Applicant: Show the total proposed matching contributions regardless of source. This number is the sum of
lines B & C, Less Proposed Cash Match and Less Proposed In-Kind Match, in the Budget Summary block
at the bottom of the Overall Budget Worksheet. This is a summary number and does not constitute
documentation of your match, which must be provided under Tab E-3.
c, d, & f: Leave Blank.
e. Other: Show amounts in the project budget, but not in the grant request or proposed matching funds. This
number is line D, Less Other Funds, in the Budget Summary block of the Overall Budget Worksheet.
g. Total: Show the total budget. This number is line A, Overall DLT Project Budget, in the Budget Summary
block of the Overall Budget Worksheet.
19. The DLT Program is subject to Executive Order 12372, Intergovernmental Review of Federal Programs.
The Order requires that grant applicants consult with State and local officials if that state has a State Local Point
of Contact (SPOC). If your state has a SPOC, you must submit a copy of your application to them at the same
time you submit your application to us. Check this website to determine if your state has a SPOC and for
contact information:
http://www.whitehouse.gov/omb/grants_spoc

T-5

The following states had a SPOC at the time this Guide was prepared. Double-check the website above when
you prepare your application to make certain that your state has not established a SPOC in the meantime. 19.
Applicants should contact the State Single Point of Contact (SPOC) for Federal Executive Order 12372 to determine whether the application is subject to the State
intergovernmental review process. Select the appropriate box. If “a.” is selected, enter the date the application was submitted to the State.

Arkansas
District of Columbia
Iowa
Maryland
Nevada
Rhode Island
Utah
Guam

California
Florida
Kentucky
Michigan
New Hampshire
South Carolina
West Virginia
North Mariana Islands
Virgin Islands

Delaware
Georgia
Maine
Missouri
North Dakota
Texas
American Samoa
Puerto Rico

20. (Required) Select the appropriate box. We cannot make a grant if you are delinquent on Federal debt.
This question applies to the applicant organization, not the person who signs as the authorized representative.
Categories of debt include delinquent audit disallowances, loans and taxes. If yes, include an explanation on a
continuation sheet.
21. The SF-424 must be signed by an authorized representative of the applicant’s organization, the organization
that will manage the project if a grant is awarded. An authorized representative is one capable of obligating the
organization. You must include evidence that the signer is authorized to obligate the organization - no
exceptions. Remember that even for large organizations in the public eye, we have no administratively practical
way of confirming the name, title, or authority of the various people who have the legal ability to obligate your
organization. Place the evidence behind the SF-424 and Site Worksheet under Tab A. Applications submitted
without evidence that the person who signed the SF-424 is so authorized will be returned as ineligible. Also,
matching funds must be documented under Tab E-3 – Leveraging. A signature on the SF 424 does not
constitute documentation in form and substance satisfactory to the Agency. All correspondence will be sent to
the contact person shown in block 8. The address and contact information provided in this block will be used
only if it duplicates block 8 or if block 8 is left blank. (Required) To be signed and dated by the authorized representative of the applicant
organization. Enter the name (First and last name required) title (Required), telephone number (Required), fax number, and email address (Required) of the person
authorized to sign for the applicant. A copy of the governing body’s authorization for you to sign this application as the official representative must be on file in the
applicant’s office. (Certain Federal agencies may require that this authorization be submitted as part of the application.)

Public reporting burden for this collection of information is estimated to average 60 minutes per response, including time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0043),
Washington, DC 20503.

T-6

Survey on Ensuring Equal Opportunity for Applicants
Reproduction of OMB No. 1890-0014 EXP 02/28/09

Purpose: The Federal government is committed to ensuring that all qualified applicants, small or large, non-religious or faith-based,
have an equal opportunity to compete for Federal funding. In order for us to better understand the population of applicants for Federal
funds, we are asking nonprofit private organizations (not including private universities) to fill out this survey.
Upon receipt, the survey will be separated from the application. Information provided on the survey will not be considered in any way
in making funding decisions and will not be included in the Federal grants database. While your help in this data collection process is
greatly appreciated, completion of this survey is voluntary.
Instructions for Submitting the Survey: If you are applying using a hard copy application, please place the completed survey in an
envelope labeled "Applicant Survey." Seal the envelope and include it along with your application package. If you are applying
electronically, please submit this survey along with your application.

Applicant’s (Organization) Name:
Applicant’s DUNS Number:
Federal Program: Distance Learning & Telemedicine Grant Program
1. Has the applicant ever received a grant or contract from
the Federal government?
Yes

No

2. Is the applicant a faith-based organization?
Yes

No

6. How many full-time equivalent employees does the
applicant have? (Check only one box.) For example, two part-time
employees who each work half-time equal one full-time equivalent
employee. If the applicant is a local affiliate of a national
organization, the responses to questions 2 and 3 should reflect the
staff and budget size of the local affiliate.

(Self-Identify)

3 or fewer
4-5
6-14

3. Is the applicant a secular organization?
Yes

No

CFDA Number 10.855

15-50
51-100
over 100

(Self-Identify)

7. What is the size of the applicant’s annual budget? (Check
4. Does the applicant have 501(c)(3) status? (501(c)(3) status
is a legal designation provided on application to the Internal
Revenue Service by eligible organizations. Some grant programs
may require non-profit applicants to have 501(c)(3) status. Others
do not.

Yes

only one box.) Annual Budget means the amount of money your
organization spends each year on all such activities.

less than $150,000
$150,000 - $299,999
$300,000 - $499,999
$500,000 - $999,999
$1,000,000 - $4,999,999
$5,000,000 or more

No

5. Is the applicant a local affiliate of a national organization?
Yes

No

(Self-Explanatory)

Paperwork Burden Statement:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection
displays a valid OMB control number. The valid OMB control number for this information collection is 1890-0014. The time required to
complete this information collection is estimated to average five (5) minutes per response, including the time to review instructions, search
existing data resources, gather the data needed, and complete and review the information collection. If you have any comments
concerning the accuracy estimate(s) or suggestions for improving this form, please write to the Agency Contact listed in this grant
application.
Reproduction of OMB No. 1890-0014 Exp. 02/28/09

T-7

T-8

2011 DLT Project

Overall Budget Worksheet
(See D-1 and D-2 in Section IV of the Application Guide)
Line
Item
No.1

Site
Name2

Unit
Cost

Description

No.

Extended
Cost

DLT %
of Use3

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.

Overall DLT Project Budget – Page 1 Subtotal

Budget Summary
A.
B.
C.
D.
E.

Overall DLT Project Budget4
5
(as documented under Tab E-3) Less Proposed Cash Match
5
(documented under Tab E-3 & In-Kind Match Worksheet) Less Proposed In-Kind Match
(from Other Funds Worksheet) Less Other Funds
DLT Grant Request (A – B – C – D = E)
(Sum of page 1 and continuation sheets subtotals)

1. Use the line-item number established on the Overall Budget Worksheet(s) on the other budget worksheets. If line-item 16 on the Overall
Budget Sheet is ineligible, show it as item 16 on the Other Funds Worksheet. Don’t start a new numbering system on each sheet.
2. For non-fixed site applications, show the operational service center out of which the financed equipment will operate.
3. This number refers to the % of use that meets the DLT Grant definition of distance learning or telemedicine, the portion eligible for
either grant or match funding. Ineligible items or items for which no funding is requested are shown as zero %, regardless of their
use in the project.
4. Line A is the sum of all DLT project extended costs as shown on this page and any continuation sheets. It includes the grant request
and all proposed matches, as well as ineligible funds that have been included in the budget.
5. Matching funds (lines B & C) must be properly documented under Tab E-3 of your application as described in detail in the
Application Guide. Any portion that is not documented will not be credited as an eligible match.

Place this Worksheet under Tab D-2 of your Application
T-9

Overall Budget Worksheet (Continuation)
Line
Item
No.1

Site
Name2

Unit
Cost

Description

No.

Extended
Cost

Overall DLT Project Budget – Page ___ Subtotal
1., 2., & 3. See footnotes on Overall Budget Worksheet

Place this sheet with other budget sheets under Tab D-2
T-10

DLT %
of Use3

2011 DLT Project

In-Kind Match Worksheet
(See D-1, D-2, & E-3 in Section IV of the Application Guide)
Proposed Matching Funds are generally cash. If any of the line-items shown on the Overall Budget Worksheet
are specified in the match documentation, they are in-kind. Show them below in the same manner (line-item
number, site name, description) as on the Overall Budget Worksheet. If only a portion is attributable to the DLT
project, show that portion here and the balance that is not eligible on the Other Funds Worksheet. In the right
column, clearly identify the source. Remember to document proposed matching funds under Tab E-3,
otherwise they will not be credited as an eligible match.
Line
Item
No1.

Site
Name2

In-Kind
Cost

Description

Source

C. Total Proposed In-Kind Match
(Insert this number in line C of the Budget Summary
on the Overall Budget Worksheet)
1. & 2. See footnotes on Overall Budget Worksheet

Make copies of this sheet if needed and label them ―continuation.‖ Place this sheet with
other budget sheets under Tab D-2
T-11

2011 DLT Project

Other Funds Worksheet
(See D-1 & D-2 in Section IV of the Application Guide)
Some line-items included in a DLT Project Budget are not eligible as either grant or match. The funds for these
must come from other sources and are designated “Other Funds.” Some line-items are only partially eligible as
grant or match. The balance of these must also come from other sources. Show all other funds below in the
same manner (line item number, site name, and description) as on the Overall Budget Worksheet. Show the
ineligible line-item cost (or portion thereof) in the Other Fund Cost column adjacent to the Source of that
funding.
Line
Item
No.1

Site
Name2

Other Fund
Cost

Description

Source

D. Total Proposed Other Funds
(Insert this number in line D of the Budget Summary
on the Overall Budget Worksheet)
1. & 2. See footnotes on Overall Budget Worksheet

Make copies of this sheet if needed and label them ―continuation.‖ Place this sheet with
other budget sheets under Tab D-2
T-12

2011 Site Worksheet - Fixed Sites (Attachment to SF 424)
Column 1.

Column 2.
Column 3.
Column 4.
Column 5.

(See A, D-1 and D-2 in Section IV of the Application Guide)
For each Hub, combined Hub/End-User, and End-User site, show its complete official name (and abbreviation should you choose to use
one). Each site name (or abbreviation) must be used consistently throughout the balance of your application. Below the site name, show
the complete street address. The address must be one that can be positively identified as described in the Application Guide. If the only
address available for a site is a PO Box, Star Route, Rural Route, or other address not locatable on a map, give that address supplemented
by the precise latitude and longitude.
For each site, show how you designate the site. i.e., as a Hub, a Hub/End-User, or End-User.
Show the County in which the site is located
Show the School District in which the site is located.
Show the Congressional District in which the site is located (example: MI 57th Dist., John Smith.)
1. Complete Site Name (Abbreviation, if any)
Complete Street Address
(DD/MM/SS or DD.DDDD if needed, see instructions)

2.
Site
Designation

3.
County

4.
School
District

5.
Congressional
District

1

2

3

4

5
You are not restricted to 5 sites. A continuation sheet follows this page. If you have many sites, use as many continuation sheets as you need.

Place this sheet behind SF-424 under Tab A of your Application
T-13

Site Worksheet - Fixed Sites (Continuation)
1. Complete Site Name (Abbreviation, if any)
Complete Street Address
(DD/MM/SS or DD.DDDD if needed, see instructions)

2.
Site
Designation

3.
County

Place this sheet behind SF-424 under Tab A of your Application
T-14

4.
School
District

5.
Congressional
District

2011 Rurality Worksheet – Fixed Sites
(For more complete guidance in completing this sheet, see E-1 in Section IV of the Application Guide)
Category
Exceptionally Rural – Any area of the US NOT included within the boundary of a
Census Urbanized Area or Urban Cluster having a population in excess of 5,000. This
includes Urban Clusters between 2500 and 5000 as well as Census Rural Areas.

Population

Points

5000 or
fewer

45

Rural – Any area of the US included within the boundary of a Census Urban Cluster
having a population over 5,000 and not in excess of 10,000.

5001 10,000

30

Mid-Rural - Any area of the United States included within the boundary of a Census
Urban Cluster over 10,000 and not in excess of 20,000.

10,001 20,000

15

20,001 or
more

0

Urban Area - Any area of the United States included within the boundary of any
Urbanized Area or Urban Cluster in excess of 20,000.

Enter each site (hub, hub/end-user, or end-user) in the table below. Place pure hubs at the beginning of the list
separated by a space and exclude them from your estimated Rurality score. To document, attach Census maps
and data sheets for each site as described in the Application Guide. For each site in a Census Designated
Urbanized Area (UA) or Urban Cluster (UC), enter the designation and population, then enter points from the
table above based on the population. For each site located in a Census Designated Rural (CR) area, show the
population as “<2500” and enter 45 points. Note – The population for sites in Census Rural areas should be
shown as “<2500” because there is no specific population associated with such an area. Any end-user site
without verifiable census documentation will be evaluated as urban (zero points). Remember that your
sites must be consistent throughout the application including on the Rurality and NSLP Worksheets, the Site
Worksheet, the Executive Summary, the Telecommunications System Plan, and the Budget. If the end-user
sites are not consistent, your application is unscorable and will be returned as ineligible.
Site Name (Location)

Site Type

(Same numbering and order as Site & NSLP Worksheets)

(Hub, etc.)

Census
Designation

Census
Rurality
Population Points

1
2

3
4
5
Applicant’s Estimated Rurality Score
(Sum of Rurality Points ÷ # of End-User Sites)

Rurality Score
(For Agency Use)

You are not restricted to 5 sites. A continuation sheet follows this page. If you have many sites, use as many continuation
sheets as you need. Be sure to indicate your estimated Rurality score for all end-user sites on this sheet.

Place this sheet and Census documentation under Tab E-1 of your Application
T-15

Rurality Worksheet – Fixed Sites (Continuation)
Site Name (Location)
(Same numbering and order as Site & NSLP
Worksheets. Number consecutively from previous sheet
)

Site Type
(Hub, etc.)

Census
Designation

Census
Rurality
Population Points

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Place Rurality Worksheets and Census Documentation under Tab E-1 of your Application
T-16

2011 NSLP Worksheet – Fixed Sites
(For more complete guidance in completing this sheet, see E-2 in Section IV of the Application Guide)
Is site
Eligible
for
NSLP?

Decision Table
Type of End-User
Public School (K-12)

Yes

Private Non Profit School (K-12)

Yes

A College or Other Educ. Org.

No

All Others - Hospital, Public
Library, Clinic, etc.

N/A

Use NSLP % for
School District
where site
located

Scoring Table

Use NSLP % for
Specific School

Yes
Yes
No
No

No
No
Yes
Yes

NSLP < 25%

Zero

25%≤NSLP<50%

15

50%≤NSLP<75%

25

NSLP ≥ 75%

35

NSLP
Eligibility %

Point
s

Enter each site in the table below placing them in the same order as on the Site Worksheet and Rurality Worksheet.
Identify the site by type. Provide data for hubs. Place pure hubs at the beginning of the list separated by a space and
do not include them in your estimated NSLP score. The Decision Table above shows whether to enter specific
school or district information for each site. Remember that your sites must be consistent throughout the application.
If the end-user sites are not consistent, your application is unscorable and will be returned as ineligible.
Any site without verifiable documentation attached behind this Worksheet will be evaluated at zero percent
eligibility. The Agency will not research undocumented data. Applicants must provide documentation for each
site’s percentage with a written certification from the organization that administers the NSLP in your area that the
data are accurate and the most recent available. Some official NSLP data is posted on state websites. If so, you may
provide printouts from these sites. Data from unofficial websites is not acceptable. Please highlight the relevant
data on the attached documentation.
Site Name
(Same numbering and order as Site & Rurality Worksheets)

Site Type
(Hub, etc.)

Total
Students

% Eligible
(See Attached)

1
2
3
4
5
Average NSLP
(Sum of NSLP Percentages ÷ # of Sites)

Applicant’s Estimated NSLP Score

NSLP Score

(Enter Points from Scoring Table)

(for Agency Use)

You are not restricted to 5 sites. A continuation sheet follows this page. If you have more sites, use as many continuation sheets as
you need. Be sure to indicate your estimated NSLP score for all end-user sites on this sheet.

Place this sheet and certified NSLP documentation under Tab E-2 of your Application
T-17

NSLP Worksheet - Fixed Sites (Continuation)
Site Name
(Same numbering and order as Site & Rurality
Worksheets)

Site Type
(Hub, etc.)

Total
Students

% Eligible
(See Attached)

6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Place NSLP Worksheets and supporting documentation under Tab E-2 of your Application
T-18

2011 Site Worksheet - Non-Fixed Sites (Attachment to SF 424)
Use the Non-Fixed Worksheets only if your application is for a non-fixed site project - ambulance, visiting nurse, etc.)
(For more complete guidance in completing this worksheet, refer to D-1 and D-2 in Section IV of the Application Guide)
Column 1 - Identify the operational service center site(s) and the service territory over which the service operates. For each service center site, show its precise
address and provide a brief description of the nature of the facility. The address must be one that can be positively identified as described in the Application Guide. If
the only address available for a site is a PO Box, Star Route, Rural Route, or other address not locatable on a map, give that address supplemented by the precise
latitude and longitude (DD/MM/SS or DD.DDDD). For example, an ambulance service would show the address of and describe its emergency vehicle operations
center. A visiting nurse project would show the central hospital or VNA offices from which it operates the service.
For the service territory, attach a detail map (as described in the Application Guide) showing the location of the service center and the defined boundary within which
the service is offered from that center. (If the service territory is not defined, we cannot score the application, which makes it ineligible for funding.) Enter a narrative
description of the service territory using as many blocks as appropriate showing the information relevant to the described territory in columns 3, 4, & 5. If the service
operates multiple, autonomous, and operationally independent territories, show each physical service center and its associated service territory separately.
Columns 2-4 - Show the relevant County, School District, and Congressional District Data associated with the sites and territory listed.

1. Sites and Service Territory (attach Detail Map)

2.
County

For Service Center Sites, complete Street Address with Brief Description
(DD/MM/SS or DD.DDDD, if needed, see Application Guide)
For Service Territory, a narrative Description that is related to Detail Map

3.
School District

1

2

3

4

5
You are not restricted to these lines. A continuation sheet follows this page. Use as many as you need.

Place this sheet behind SF-424 under Tab A of your Application
T-19

4.
Congressional. District

Site Worksheet - Non-Fixed Sites (Continuation)
1. Sites and Service Territory (attach Detail Map)

2.
County

For Service Center Sites, complete Street Address with Brief Description
(DD/MM/SS or DD.DDDD, if needed, see Application Guide)
For Service Territory, a narrative Description that is related to Detail Map

3.
School District

Place this sheet behind SF-424 under Tab A of your Application
T-20

4.
Congressional. District

2011 Rurality Worksheet – Non-Fixed Sites
Use the Non-Fixed Worksheets only if your application is for a non-fixed site project - ambulance, VNA, etc.
(For more complete guidance in completing this sheet, refer to E-1 in Section IV of the Application Guide)
Category
Population Points
Exceptionally Rural – Any area of the US NOT included within the boundary of a
5000 or
Census Urbanized Area or Urban Cluster having a population in excess of 5,000. This
45
fewer
includes Urban Clusters between 2500 and 5000 as well as Census Rural Areas.
Rural – Any area of the US included within the boundary of a Census Urban Cluster
having a population over 5,000 and not in excess of 10,000.

5001 10,000

30

Mid-Rural - Any area of the United States included within the boundary of a Census
Urban Cluster over 10,000 and not in excess of 20,000.

10,001 20,000

15

20,001 or
more

0

Urban Area - Any area of the United States included within the boundary of any
Urbanized Area or Urban Cluster in excess of 20,000.

Projects not based on an officially defined service territory documented by Census data can not be scored and
will be returned as ineligible. Place each Census Designated Urbanized Area (UA) and Urban Cluster (UC) in
the service territory on an individual row in column 1, enter the Census Designation in column 2, and attach Census
data printouts showing the population of each in column 3. From the table above, enter points in column five based
on the population of the UA or UC. Enter the entire population of the UA or UC in column 4 unless you have
demonstrated in your application that your defined service territory excludes part of the UA or UC. (See the
Application Guide for additional guidance.) If you have so demonstrated, enter the portion you serve in Column 4.
Enter the Census Rural (CR, below 2500) population(s) separately as appropriate and provide census data sheets to
support the number(s). For Census Rural population(s), enter 45 points in column 5. Enter the product of columns 4
and 5 in column 6. Divide the sum of column 6 by the sum of column 4 to obtain your estimated score.

1. Service Territory Population Centers
(List each Urbanized Area & Urban Cluster on a separate
line. Show Census Rural Area(s) separately.

3.
2.
4. Population in
5.
Census
Census
Service
Rurality
Designation Population Territory
Points

6. Product
(4 X 5 = 6)

1
2
3
4
5
Sum Rows 1-5 of columns 4 & 6 ►
(include any additional rows from continuation sheets)

Applicant’s Estimated Rurality Score
(Sum of Column 6 ÷ Sum of Column 4)

Rurality Score
(For Agency Use)

A continuation sheet follows this page. Use as many as you need.

Place this sheet and Census documentation under Tab E-1 of your Application
T-21

Rurality Worksheet – Non-Fixed Sites (Continuation)
1. Service Territory Population Centers
(List each urbanized area & urban cluster on a separate
line. Show the entire Census Rural Area on one line.

3.
2.
4. Population
5.
Census
Census
in Service Rurality
Designation Population Territory
Points

6. Product
(4 X 5 = 6)

Place Rurality Worksheets and Census documentation under Tab E-1 of your Application
T-22

2011 NSLP Worksheet – Non-Fixed Sites
Use the Non-Fixed Worksheets only if your application is for a non-fixed site project - ambulance, VNA, etc.
(For more complete guidance in completing this sheet, refer to E-2 in Section IV of the Application Guide)

Scoring Table
NSLP Eligibility %

Points

NSLP < 25%

Zero

25%≤NSLP<50%

15

50%≤NSLP<75%

25

NSLP ≥ 75%

35

In column 1, enter the name of each School District into which the service offered by the applicant extends,
whether that area coincides with the entire School District in whole or in part. Enter the number of students in that
district and the percentage that are eligible for the National School Lunch Program in columns 2 and 3.
Any site without verifiable documentation attached behind this Worksheet will be evaluated at zero percent
eligibility. The Agency will not research undocumented data. Applicants must provide documentation of each
school district’s percentage with a written certification from the organization that administers the NSLP in your
area that the data are accurate and the most recent available. Some official NSLP data is posted on state websites.
If so, you may provide printouts from these websites. Data from unofficial websites is not acceptable. Please
highlight the relevant data on the attached documentation.
School District Name

Total Students

% Eligible
(See Attached)

1
2
3
4
5
Average NSLP
(Sum of NSLP Percentages ÷ # of School Districts)

Applicant’s Estimated NSLP Score

NSLP Score

(Enter Points from Scoring Table)

(for Agency Use)

A continuation sheet follows this page. Use as many as you need. Be sure to include continuation sheet data in the average.

Place this sheet and supporting documentation under Tab E-2 of your Application
T-23

NSLP Worksheet – Non-Fixed Sites (Continuation)
School District Name

Total Students

% Eligible
(See Attached)

6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Place NSLP Worksheets and supporting documentation under Tab E-2 of your Application
T-24

2011 Leveraging Worksheet
(Matching Funds – For more complete guidance, see E-3 in Section IV of the Application Guide)

The applicant must demonstrate an eligible match of at least 15% of the grant request.
To be credited, the proposed match must be for eligible purposes. If the Agency cannot fund an item if
it were in the grant request, we cannot accept it as match.
As an applicant, you submit a proposed match and estimated score. The eligibility of the match and
actual score is determined by the Agency.
You must document your matching funds as described in the Application Guide. Place letters of
financial commitment and other match documentation along with this form under TAB E-3 of your
application package. Each donor’s match as listed below must be supported by a matching letter. If you
have more than ten donors, use another copy of this sheet and label it “continuation.”
Matches not properly documented
behind this Sheet under Tab E-3
will not be credited. Depending on
the consequent reduction of your
match, this could lower your score
or make your project ineligible
(i.e., if resultant match is < 15%)

Eligible Match ÷ Eligible Grant Request (%)

Points

15% < Match % ≤ 30%

0

30% < Match % ≤ 50%

15

50% < Match % ≤ 75%

25

75% < Match % ≤ 100%

30

Match > 100%

35

Donor
(place documentation letter from each donor, including the applicant, behind this sheet)

Proposed Match

i.

$

ii.

$

iii.

$

iv.

$

v.

$

vi.

$

vii.

$

viii.

$

ix.

$

x.

$
1. Total proposed matching contributions (sum of i thru x):

$

2. Total DLT Grant requested:

$

3. Match as Percent of Grant Request (Line1

Line 2 100%):

%

Applicant’s Estimated Leveraging Score

Leveraging Score

(Enter Points from Scoring Table)

(For Agency Use)

Place this sheet and supporting documentation under Tab E-3 of your Application
T-25

2011 EZ Worksheet
(USDA Empowerment Zone Worksheet)
(See Section E-4 of the Application Guide)
If any of your sites are located in a USDA Empowerment Zone, your application may be eligible for points in
this category. Check the official website shown below for USDA designated areas. Ten points can be earned if
at least 1 end-user site is in an Empowerment Zone. (Additional sites located in that or another Empowerment
Zone do not earn additional points.) The maximum score an applicant can earn in this category is ten points for
having at least one site in an Empowerment Zone.
(Important Note: In prior years, up to 10 points were awarded under this category for sites located in
designated USDA Enterprise Communities (EC) and Champion Communities (CC). These designations are no
longer in effect. See Section E-4 of the Application Guide for details about this change.
http://www.rurdev.usda.gov/SupportDocuments/BCP-EZECList.doc
List end-user sites that are in an Empowerment Zone in the table below. Any end-user site shown on this
Worksheet must be consistent with the sites shown on the Rurality and NSLP Worksheets. To document the EZ
status of the site, place printouts from the USDA websites shown above behind this Worksheet under Tab
E-4. If not properly documented behind this Worksheet under Tab E-4, no points will be awarded in this
category.

End-User Site Name

Empowerment Zone Name

1
2
3

Applicant’s Estimated EZ Score
(Enter Points from Scoring Table)

EZ Score
(For Agency Use)

Place this sheet and supporting documentation under Tab E-4 of your Application
T-26

2011 Additional NSLP Worksheet
(See more complete information about additional NSLP, see F-1 in Section IV of the Application Guide)

The NSLP eligibility percentage on our NSLP Worksheet (Tab E-2) is: __________

If this percentage is under 50%, and you believe your NSLP eligibility percentage does not accurately reflect
the economic conditions in your area compared to other areas with similar eligibility percentages, you have the
option to request additional points here. (If the eligibility on your NSLP Worksheet is 50% or higher, but you
suspect that the percentage could drop below 50% after Agency review of your application, you may also
request these points. Such a request will be acted upon only if your final NSLP eligibility is below 50% as
determined by the Agency.) Points awarded by the Agency in this category, if any, are based on the supporting
information provided. Attach your supporting documentation behind this worksheet under Tab F-1.
Requests for Additional NSLP will not be considered if not accompanied by supporting documentation
(i.e., no Additional NSLP points will be awarded).

I hereby request additional NSLP Points and have attached documentation
behind this Worksheet to support my request.

________________________________________________
Signature of Authorized Representative
(Same person who signed the SF - 424, Application for Federal Assistance)

_____________________________________________
Date

Additional NSLP Points
(for Agency Use)

Place this sheet and supporting documentation under Tab F-1 of your Application
T-27

Equal Opportunity and Nondiscrimination Certification
All grants made under 7 CFR 1703 are subject to the nondiscrimination provisions of Title VI of the Civil
Rights Act of 1964, as amended, (7 CFR 15); Section 504 of the Rehabilitation Act of 1973, as amended, (29
U.S.C. 901 et seq.; 7 CFR 15b); and the Age Discrimination of 1975, as amended (42 U.S.C. 6101 et seq.; 45
CFR 90), and as amended by Executive Order 11375 Amending Executive Order 11246, Relating to Equal
Employment Opportunity (3 CFR, 1966, 1970 Comp., p. 684).
As a prospective primary participant recipient of financial assistance from RUS, this organization commits to
carry out RUS’ established policy to comply with the requirements of the above laws and executive orders to
the effect that no person in the United States shall, “on the basis of race, color, national origin, handicap, or age,
be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under
the RUS Distance Learning and Telemedicine Loan and Grant Programs.”
The __________________________________________________ (Grantee)
hereby certifies that, as a prospective recipient under the said Distance Learning and Telemedicine Loan and
Grant Program, it will comply with the above referenced laws, regulations and Executive Orders.

____________________________
Date

__________________________________________
Signature
__________________________________________
Type or Print Name
__________________________________________
Title

Place this Certification under Tab H of your Application
C-1

Certificate Regarding Architectural Barriers
All facilities financed with RUS grants that are open to the public, or in which physically handicapped persons
may be employed or reside, must be designed, constructed, and/or altered to be readily accessible to and usable
by handicapped persons. Standards for these facilities must comply with the Architectural Barriers Act of 1968,
as amended (42 U.S.C. 4151 et seq.), and with the Uniform Federal Accessibility Standards (UFAS), (Appendix
A to 41 CFR subpart 101-19.6).
As a prospective primary participant recipient of financial assistance from RUS, this organization commits to
carry out RUS’ established policy to comply with the requirements of the above referenced law to the effect that
all facilities must be readily accessible to and usable by handicapped persons.
The _______________________________________ (Grantee) hereby certifies, that, as a prospective recipient
under the Distance Learning and Telemedicine Grant and Loan Program, it is in compliance, or will be in
compliance upon completion of the project, with the above referenced law.

____________________________
Date

__________________________________________
Signature
__________________________________________
Type or Print Name
__________________________________________
Title

Place this Certification under Tab H of your Application
C-2

Certificate Regarding Flood Hazard Area Precautions
In accordance with 7 CFR 1788, if the project is in an area subject to flooding, flood insurance must be
provided to the extent available and required under the National Flood Insurance Act of 1968, as amended by
the Flood Disaster Protection Act of 1973, as amended (42 U.S.C. 4001-4128). If applicable, the insurance must
cover, in addition to the buildings, any machinery, equipment, fixtures, and furnishings contained in the
buildings. RUS will comply with Executive Order 11988, Floodplain Management (3 CFR, 1977 Comp., p.
117), and 7 CFR 1794.41, of this chapter in considering the application for the project.
Please check the appropriate line below:
___ a) The project is not located in a 100-year flood plain; therefore, no Flood Insurance is required.
___ b) The project is located in a 100-year flood plain and the required insurance is or will be provided by:
____________________________________
____________________________________
____________________________________
The _______________________________________ (Grantee) hereby certifies, that, as a prospective recipient
under the Distance Learning and Telemedicine Loan and Grant Program, it is in compliance, or will be in
compliance during construction and/or installation of equipment and upon completion of the project, with the
above referenced law.

____________________________
Date

__________________________________________
Signature
__________________________________________
Type or Print Name
__________________________________________
Title

Place this Certification under Tab H of your Application
C-3

Uniform Relocation Assistance and Real Property Acquisition
Policies Act of 1970 Certification
The _________________________________________________________ (Grantee) assures that it will
comply with the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (Uniform
Act) as amended, 42 U.S.C. 4601-4655, and with implementing Federal regulations in 49 CFR 24 and 7 CFR
21.

Specifically, the ________________________________________________ (Grantee) assures that:
Whenever Federal financial assistance is used to pay for any part of the cost of a program or project which
will result in the displacement of any person;
(a) Fair and reasonable relocation payments and assistance shall be provided to or for displaced
persons in accordance with sections 202, 203, and 204 of the Uniform Act,
(b) Relocation assistance programs offering the services described in section 205 of the Uniform Act
shall be provided to displaced persons, and
(c) Within a reasonable period of time prior to displacement, comparable replacement dwellings will
be available to displaced persons in accordance with section 205(c) (3) of the Uniform Act.

____________________________
Date

__________________________________________
Signature of President or Authorized Official of
Ultimate Recipient

Place this Certification under Tab H of your Application
C-4

Certification Regarding Drug-Free Workplace Requirements for Grantees Other
than Individuals
This certification is required by the regulations implementing Sections 5151-5160 of the Drug-Free Workplace
Act of 1988 (P.L. 100-690, Title V, Subtitle D; 41 U.S.C. 701 et seq.), 7 CFR 3017.600.
A. The grantee certifies that it will or will continue to provide a drug-free workplace by:
(a) Publishing a statement notifying employees that unlawful manufacture, distribution, dispensing,
possession, or use of a controlled substance is prohibited in the grantee’s workplace and specifying the
actions that will be taken against employees for violation of such prohibition;

(b) Establishing an ongoing drug-free awareness program to inform employees about:
(1) The dangers of drug abuse in the workplace;
(2) The grantee’s policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) The penalties that may be imposed upon employees for drug abuse violations occurring in the
workplace;
(c) Making it a requirement that each employee to be engaged in the performance of the grant be given a
copy of the statement required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment
under the grant, the employee will:
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute
occurring in the workplace no later than 5 calendar days after such conviction;
(e) Notifying the Agency in writing, within 10 calendar days after receiving notice under subparagraph (d)
(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted
employees must provide notice, including position title, to every grant officer on whose grant activity
the convicted employee was working, unless the Federal agency has designated a central point for the
receipt of such notices. Notice shall include the identification number(s) of each affected grant;
Page 1 of 2

C-5a

(f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph
(d)(2), with respect to any employee who is so convicted:
(1) Taking appropriate personnel action against such an employee, up to and including termination,
consistent with the requirements of the Rehabilitation Act of 1973, as amended; or
(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation
program approved for such purposes by a Federal, State, or local health, law enforcement, or other
appropriate agency;
(g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of
paragraphs (a), (b), (c), (d), (e), and (f).
B. The grantee may insert in the space provided below the site(s) for the performance of work done in
connection with the specific grant:

Place of Performance:

______________________________________________________________________________
Street Address
City

______________________________________________________________________________
County
State
Zip Code

____ Check if there are workplaces on file that are not identified here.

__________________________________________
Organization Name
__________________________________________
Name and Title of Authorized Representative
__________________________________________
Signature

_________________________
Date
Page 2 of 2

Place this Certification under Tab H of your Application
C-5b

Certification Regarding Debarment, Suspension, and Other Responsibility
Matters—Primary Covered Transactions
This certification is required by the regulations implementing Executive Order 12549, Debarment and
Suspension, 7 CFR 3017.510.
(1) The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals:
(a) are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from covered transactions by any Federal department or agency;
(b) have not within a 3-year period preceding this proposal been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a
public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft,
forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen
property;
(c) are not presently indicted for or otherwise criminally or civilly charged by a governmental entity
(Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this
certification; and
(d) have not within a 3-year period preceding this application/proposal had one or more public transactions
(Federal, State, or local) terminated for cause or default.
(2) Where the prospective primary participant is unable to certify to any of the statements in this certification,
such prospective participant shall attach an explanation to this proposal.

__________________________________________
Organization Name
__________________________________________
Name and Title of Authorized Representative
__________________________________________
Signature

_________________________
Date

Place this Certification under Tab H of your Application
C-6

Certification Regarding Lobbying for Contracts, Grants, Loans, and Cooperative
Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, 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 awarding of any Federal contract, the making of any Federal grant or loan, the entering into of
any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of
any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than 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 this
Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit
Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.
(Copies of this form may be obtained from RUS.)
(3) The undersigned shall require that the language of this certification be included in the award documents
for all sub awards at all tiers (including subcontracts, sub grants, and contracts under grants, loans, and
cooperative agreements) and that all sub recipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by 31 U.S.C. 1352. Any person who fails to file the required certification shall be subject
to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

__________________________________________
Organization Name
__________________________________________
Name and Title of Authorized Representative
__________________________________________
Signature

_________________________
Date

Place this Certification under Tab H of your Application
C-7

Non-Duplication of Services Certificate
As a prospective primary participant recipient of assistance from RUS, this organization commits to carry out
RUS’ established policy to comply with the requirements that no facilities using financial assistance will
duplicate adequate established telemedicine services and/or distance learning services.
The ______________________________________________ (Grantee) hereby certifies that as a prospective
recipient under the said Distance Learning and Telemedicine Loan and Grant Program, that it will not use RUS
grant funds to duplicate any adequate established services as referenced above.
(Note: Applicants and participants in DLT grant applications are sometimes applicants or participants in other
current year applications or are sometime applicants or participants in projects that received awards in prior
years. For guidance on disclosing such situation with respect to duplication of adequate established services,
please refer to “Include the Following in your TSP” under D-1, Telecommunications System Plan, in Section IV
of the Application Guide.)

____________________________
Date

__________________________________________
Signature
__________________________________________
Type or Print Name
__________________________________________
Title

Place this Certification under Tab H of your Application
C-8

Environmental Impact Certification
Environmental Project Summary:

(This description should encompass all construction in the project, no matter the source of funding. It should
provide details of how the project will affect the environment (wetlands, farmlands, floodplain, cultural
environment, endangered species, environmental quality, and historic preservation). If additional space is
needed, continue on white bond paper and attach to this certification.)

CERTIFICATION
I hereby certify that the construction proposed in this application will not adversely impact the
environment or historic preservation.
_____________________________________________
(Signature and Date)
_____________________________________________
(Print or Type Title)

Place this Certification under Tab H of your Application
C-9