HEP GPRA Form

HEP Performance Report Grant Year: Y1___ Y2___ Y3___ Y4___ Y5___

Project Name: Sample University Reporting Period: _ _/_ _/20_ _ - _ _/_ _/20_ _

PR Number: S141A_ _ _ _ _ _ Example of Reporting Period: 07/01/20_ _ – 06/30/20_

The HEP GPRA 1 Documentation Form

Directions: Please complete the table below by providing the following information.

For Final Performance Reports, the table should reflect the students who attained a high school equivalency (HSE) certification during the Year 5 reporting period.

• Student Name. Provide the first name, middle initial, and last name of each student who attained a HSE high school equivalency certification during the current reporting period.

• HSE Certificate Number. Provide the unique number affixed to the HSE attainer’s certificate.

• The date of the last sub-test taken. Provide the exact date that the HSE attainer took the last sub-test in order to pass the HSE. Provide this information in the form of Month/Day/Year (e.g. 3/29/2011).

• Did the date of the last sub-test occur during the current reporting period? Provide a “Yes” or “No” answer to this question. All HSE attainers that you count in this report (all students that are listed on this page) should have taken the last sub-test during the current reporting period.

	Student Name	HSE Certificate Number	The date of the last sub-test taken and passed that yielded the HSE certificate (MO/DAY/YR)	Did the date of the last sub-test occur during the current reporting period? (Yes/No)
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Directions: Provide the appropriate signatures below so that the HEP director and HEP authorized representative attest to the accuracy of the information provided above. Please read the statement below and provide the required signatures.

I have verified and attest to the fact that all students who are listed above were enrolled in the ______________________________ HEP project and attained their HSE during the current reporting period.

________________________________________________________ _________________

(Signature of HEP Director) (Signature Date)

_________________________________________________________ _________________

(Signature of HEP Authorized Representative) (Signature Date)

This list must be: 1) Completed as a Word document; 2) Scanned into PDF format (to capture authorizing signatures); and 3)uploaded into the G5 system as a “Narrative.” Please note that this process is unlike the uploading process for the APR. Instead of being scanned into a PDF, the APR must be converted into a PDF using the Adobe feature and then uploaded into G5 as a “Narrative.”

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