Form 1810-0687 Housing Offical Certification Form

U.S. DEPARTMENT OF EDUCATION
Impact Aid Program
HOUSING UNDERGOING RENOVATION OR REBUILDING CERTIFICATION
1.
2.
3.
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5.
6.

HOUSING OFFICIAL NAME
HOUSING OFFICIAL TITLE
NAME OF MILITARY INSTALLATION OR TRIBAL HOUSING AREA
HOUSING OFFICIAL EMAIL ADDRESS
HOUSING OFFICAL PHONE NUMBER
ESTIMATED NUMBER OF SCHOOL AGE CHILDREN WHO
WOULD HAVE RESIDED IN UNITS HAD THEY NOT BEEN
UNDERGOING RENOVATION OR REBUILDING
7. DATE HOUSING PROJECT BEGAN
8. SCHOOL DISTRICT SURVEY DATE
9. NUMBER OF SCHOOL AGE CHILDREN REPORTED ON TABLES 1
AND 3 FOR EITHER MILITARY LIVE-ON OR INDIAN LANDS
CHILDREN FOR THE FY 2014 IMPACT AID APPLICATION
I certify that, to the best of my knowledge, the estimated number of school age children above represents the number of
children who would have resided in housing on Federal property if the housing was not undergoing renovation or
rebuilding. In addition, the units used as the basis for this calculation do not include any units vacant for less than 30 days
or units vacant for minor or sustainment repairs.

AUTHORIZED REPRESENTATIVE SIGNATURE

DATE

INSTRUCTIONS
Line 1 – Verify the contact person named on Line 1 is the appropriate person for providing and certifying information related to
ongoing housing projects.
Line 2 – Verify the title of the contact person listed on Line 1.
Line 3 – Verify the name of the military installation or Indian lands housing area.
Line 4 – Verify the email address of the housing official.
Line 5 – Verify the phone number of the housing official.
Line 6 – Enter the estimated number of school-age children who would have resided in the housing had it not been undergoing
renovation or rebuilding. We have provided a suggested methodology for your use, although you may certify a number of
school-aged children based on your records.
Step 1 : number of school age children (see line 9) ÷ number of occupied units = average number of school age children per
unit.
Step 2: average number of school age children per unit x the number of units undergoing renovation or rebuilding on the
survey date = average number of school age children that would have resided in the housing had it not been undergoing
renovation or rebuilding.
Line 7 – Enter the date the construction project began. If there are multiple overlapping construction projects, please enter the
earliest project start date.
Line 8 – The survey date is provided by the school district. This is the date you should use to determine the number of units
vacant due to renovation or rebuilding projects lasting longer than 30 days and that are not sustainment projects.
Line 9 – The number of school age children residing in military or Indian Lands housing on the survey date. This number may be
used in calculating Step 1 of Line 6 above.

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