Application for Grants Under the Predominantly Black Institutions Formula Grant Program

2017 Final PBI Formula Application. 02.16.17 clean

Application for Grants Under the Predominantly Black Institutions Formula Grant Program

OMB: 1840-0812

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U.S. DEPARTMENT OF EDUCATION

OFFICE OF POSTSECONDARY EDUCATION

WASHINGTON, DC 20202

Fiscal Year 2017

APPLICATION FOR GRANTS

PREDOMINANTLY BLACK INSTITUTIONS FORMULA GRANT PROGRAM

CFDA No. 84.031P

APPLICATION AVAILABLE DATE:

TBD

CLOSING DATES:

PHASE I: TBD

PHASE II: TBD

OMB No. 1840-0812

Expires: __/__/2020

TABLE OF CONTENTS

Dear Applicant Letter 3

Competition Highlights 5

Overview of Program 6

Requirements and Funding Rules 9

Statute 10

Closing Date Notice 15

Instructions for Completing the Application

Part I: Formula Elements 16

Part II: Project Plan 19

Goals and Objectives Form 22

Part III: Standard Forms and Certifications

Application for Federal Assistance (SF 424) 24

Instructions for the SF 424 27

Supplemental Information Required for Department of Education 29

Instructions for Supplement to SF 424 30

Definitions for Supplement to SF 424 31

ED 524 Budget Information 34

Instructions for ED 524 36

Assurances - Non-Construction Programs 38

Certification Regarding Lobbying 40

GEPA 41

Disclosure of Lobbying Activities SF-LLL 42

GPRA 44

Application Transmittal Instructions 46

OMB Burden Statement 47

Dear Applicant:

Thank you for your interest in applying for a fiscal year (FY) 2017 grant under the Predominantly Black Institutions (PBI) Formula grant program. This program was established by the Higher Education Opportunity Act of 2008 and is authorized under Title III, Part A, Section 318 of the Higher Education Act of 1965, as amended (HEA). The purpose of the PBI program is to assist eligible institutions in expanding educational opportunities for their students through a program of Federal assistance. A copy of the statute for this program and all instructions and forms required to apply for a grant are included in this application booklet.

To be eligible to apply for a grant under the PBI program, institutions of higher education must first apply for and be designated as eligible institutions for Title III and Title V funding. Information about applying for designation as an eligible institution may be found at: http://www2.ed.gov/programs/pbihea/index.html.

Institutions must also meet the statutory definition of a PBI, and must not be receiving assistance under other programs in Parts A and B of Title III or Part A of Title V; or be authorized to receive an annual appropriation under the Act of March 2, 1867 (14 Stat. 438; 20 U.S.C. 123).

All eligible institutions who qualify as PBIs and submit the required application materials in accordance with the instructions will receive a portion of the total appropriation for the PBI Formula grant program. Funds to eligible PBIs will be awarded based on the funding formula included in the program statute.

Please read carefully the Notice Inviting Applications (NIA) for New Awards for this program that was published in the Federal Register and is included in this application. The NIA includes information on the deadline for transmittal of applications and other program requirements. Do not follow any guidance that is in conflict with the contents of the NIA.

Please note that there are two deadlines for transmittal of application materials, each pertaining to different phases of the application process. Phase I of the application involves the submission of data necessary to determine statutory eligibility and apply the funding formula that determines the amount each eligible institution will receive. Phase II of the application involves the submission of the narrative project plan, abstract, and all standard forms, including the SF 524 Budget form and narrative. The deadlines for submission of Phase I and Phase II of the application are listed in the NIA.

Page 2 – Dear Applicant

If you have any questions or require additional information, please contact Bernadette D. Miles via email at bernadette.miles@ed.gov or by phone at (202) 453-7892.

I appreciate your interest in the PBI program and look forward to receiving your application.

Sincerely,

Dr. Josephine A. Hamilton

Director

HBCU and PBI Grants Division

Institutional Service

COMPETITION HIGHLIGHTS

The Predominantly Black Institutions (PBI) Program was established by the Higher Education Opportunity Act of 2008 and is authorized under Title III, Part A of the Higher Education Act of 1965, as amended (HEA). The PBI program makes grant awards for up to five years to eligible institutions to plan, develop, undertake and implement programs to enhance the institution’s capacity to expand higher education opportunities for low-income and Black American students. A copy of the statute for this program and all instructions and forms necessary to apply for grants are included in this application booklet.

To be eligible to apply for a grant under the PBI program, institutions of higher education must first apply for and be designated eligible institutions for Title III and Title V funding. Information about applying for designation as an eligible institution may be found at http://www2.ed.gov/programs/pbihea/index.html. Institutions must also meet the program-specific eligibility requirements described in the statute. Institutions classified as a Historically Black College or University (HBCU) are not eligible to apply for this program.

The amount allotted to each PBI under this program may not be less than $250,000. If the amount appropriated for this program for a fiscal year is not sufficient to pay the minimum allotment to eligible institutions, then the amount of the minimum allotment must be ratably reduced, in accordance with the statute.

Amounts will be awarded based on a formula. All institutions that meet the statutory definition of a PBI and submit the required materials will receive a portion of the total appropriation. The amount that an eligible institution receives depends on a formula based on the number of Federal Pell Grant recipients, the number of graduates, and the number of graduates seeking a higher degree at that institution.

The application process will have two phases.

In Phase 1, applicant institutions will submit the data requested in Part I of the application, demonstrating that they meet the program-specific eligibility requirements, and enabling program staff to calculate how much funding the institution qualifies for based on the formula contained in the statute.

In Phase 2, Parts II and III of the application will be submitted after the institution is informed by the Department how much funding it will receive based on the data submitted by the institution in Part I. Part II includes the budget, budget narrative, and a project narrative of no more than 50 pages describing the project activities, the goals and objectives of the project, and an evaluation plan including performance measures. Part III of the application includes the standard forms and certifications.

Deadline for Submitting Phase 1 Data: TBD

Deadline for Submitting Phase 2 Data: TBD

PREDOMINANTLY BLACK INSTITUTIONS FORMULA GRANT PROGRAM

AUTHORIZING LEGISLATION

Higher Education Act of 1965 as amended (HEA), Title III, Part A, Section 318.

APPLICABLE REGULATIONS

Education Department Administrative Regulations (EDGAR), Parts 75, 77, 79, 81, 82, 84, 85, 86, 97, 98 and 99; and Uniform Guidance 2 CFR part 200.

OVERVIEW OF PROGRAM

Purpose:

The Predominantly Black Institutions (PBI) Program makes five-year grant awards to eligible institutions to plan, develop, undertake and implement programs to enhance the institution’s capacity to serve more low- and middle-income Black American students; to expand higher education opportunities for eligible students by encouraging college preparation and student persistence in secondary school and postsecondary education; and to strengthen the financial ability of the institution to serve the academic needs of these students.

Eligibility:

To be eligible to apply for a grant under the PBI program, institutions of higher education must first apply for and be designated eligible institutions for Title III and Title V funding. Information about applying for designation as an eligible institution may be found at http://www2.ed.gov/programs/pbihea/index.html.

To be eligible, an institution of higher education must--

have an enrollment of needy undergraduate students;

have an average educational and general expenditure that is low, per full-time equivalent undergraduate student, in comparison with the average educational and general expenditure per full-time equivalent undergraduate student of institutions that offer similar instruction;
have an enrollment of undergraduate students that is not less than 40 percent Black American students;
be legally authorized to provide, and provide, within the State an educational program for which the institution of higher education awards a baccalaureate degree or, in the case of a junior or community college, an associate's degree;
be accredited by a nationally recognized accrediting agency or association determined by the Secretary to be a reliable authority as to the quality of training offered or is, according to such an agency or association, making reasonable progress toward accreditation;
not be receiving assistance under other programs in Parts A and B of Title III or Part A of Title V; or be authorized to receive an annual appropriation under the Act of March 2, 1867 (14 Stat. 438; 20 U.S.C. 123);
have not less than 1,000 undergraduate students;
have not less than 50 percent of undergraduate students enrolled that are low-income individuals or first-generation college students; and
have not less than 50 percent of the undergraduate students enrolled in an educational program leading to a bachelor's or associate's degree that the eligible institution is licensed to award by the State in which the eligible institution is located.

Enrollment of Needy Students – For purposes of this part, the term “enrollment of needy students” means enrollment at an eligible institution with respect to which not less than 50 percent of the undergraduate students enrolled in an academic program leading to a degree—

in the second fiscal year preceding the fiscal year for which the determination is made, were Federal Pell Grant recipients for such year;
come from families that receive benefits under a means-tested Federal benefit program;
attended a public or nonprofit private secondary school that--

is in the school district of a local educational agency that was eligible for assistance under part A of title I of the Elementary and Secondary Education Act of 1965 for any year during which the student attended such secondary school; and
for such year of attendance, was determined by the Secretary (pursuant to regulations and after consultation with the State educational agency of the State in which the school is located) to be a school in which the enrollment of children meeting a measure of poverty under section 1113(a)(5) of such Act exceeds 30 percent of the total enrollment of such school; or

are first-generation college students and a majority of such first-generation college students are low-income individuals.

Low-Income Individual – For the purpose of this part, the term “low-income individual” means an individual from a family whose taxable income for the preceding year did not exceed 150 percent of an amount equal to the poverty level determined by using criteria of poverty established by the Bureau of the Census.

First Generation College Student – For the purposes of this part, the term “first generation college student” means -

an individual both of whose parents did not complete a baccalaureate degree; or
in the case of any individual who regularly resided with and received support from one parent, an individual whose only such parent did not complete a baccalaureate degree.

Means-tested Federal Benefit Program – a program of the Federal Government, other than a program under title IV of the HEA, in which eligibility for the program's benefits, or the amount of such benefits, are determined on the basis of income or resources of the individual or family seeking the benefit.

Authorized Activities:

Grant funds may be used for the following activities:

Academic instruction in disciplines in which Black Americans are underrepresented.
Establishing or enhancing a program of teacher education designed to qualify students to teach in a public elementary school or secondary school in the State that must include, as part of such program, preparation for teacher certification or licensure.
Establishing community outreach programs that will encourage elementary school and secondary school students to develop the academic skills and the interest to pursue postsecondary education.
Purchase, rental, or lease of scientific or laboratory equipment for educational purposes, including instructional and research purposes.
Construction, maintenance, renovation, and improvement in classrooms, libraries, laboratories, and other instructional facilities, including the integration of computer technology into institutional facilities to create smart buildings.
Support of faculty exchanges, faculty development, and faculty fellowships to assist in attaining advanced degrees in the field of instruction of the faculty.
Development and improvement of academic programs.
Purchase of library books, periodicals, and other educational materials, including telecommunications program material.
Tutoring, counseling, and student service programs designed to improve academic success, including innovative, customized, instruction courses designed to help retain students and move the students rapidly into core courses and through program completion, which may include remedial education and English language instruction.
Education or counseling services designed to improve the financial literacy and economic literacy of students or the students' families.
Funds management, administrative management, and acquisition of equipment for use in strengthening funds management.
Joint use of facilities, such as laboratories and libraries.
Establishing or improving a development office to strengthen or improve contributions from alumni and the private sector.
Establishing or improving an endowment fund.
Creating or improving facilities for Internet or other distance learning technologies, including purchase or rental of telecommunications technology equipment or services.
Other activities proposed in the application that--

contribute to carrying out the purpose of the PBI Program; and
are approved by the Secretary as part of the review and approval of an application.

REQUIREMENTS AND FUNDING RULES

Endowment Funds:

A PBI may use not more than 20 percent of the grant funds to establish or increase an endowment fund at the institution. In order to be eligible to use grant funds to establish or increase an endowment, a PBI must provide matching funds from non-Federal sources, in an amount equal to or greater than the Federal funds used for the establishment or increase of the endowment fund. The provisions of part C of Title III apply to the establishment or increase of an endowment fund under the PBI program.

Construction:

Not more than 50 percent of the grant funds provided to a PBI under this program may be used for constructing or maintaining a classroom, library, laboratory, or other instructional facility.

Minimum Award:

The amount allotted to each PBI may not be less than $250,000. If the amount appropriated for this program for a fiscal year is not sufficient to pay the minimum allotment, then the amount of the minimum allotment must be ratably reduced.

Funding Formula:

Grant amounts to PBIs will be awarded according to the following formula:

Federal Pell Grants- From the amount appropriated for this program for any fiscal year, the Secretary must allot to each PBI a sum that bears the same ratio to one-half of that amount as the number of Federal Pell Grant recipients in attendance at such institution at the end of the academic year preceding the beginning of that fiscal year, bears to the total number of Federal Pell Grant recipients at all such institutions at the end of such academic year.

Graduates- From the amount appropriated for this program for any fiscal year, the Secretary will allot to each PBI a sum that bears the same ratio to one-fourth of that amount as the number of graduates for such academic year at such institution, bears to the total number of graduates for such academic year at all such institutions.

(3) Graduates Seeking a Higher Degree- From the amount appropriated for this program for any fiscal year, the Secretary must allot to each PBI a sum that bears the same ratio to one-fourth of that amount as the percentage of graduates from such institution who are admitted to and in attendance at, not later than two years after graduation with an associate's degree or a baccalaureate degree, a baccalaureate degree-granting institution or a graduate or professional school in a degree program in disciplines in which Black American students are underrepresented, bears to the percentage of such graduates for all such institutions.

PREDOMINANTLY BLACK INSTITUTIONS PROGRAM STATUTE

SEC. 318. (NOTE: 20 USC 1059e) PREDOMINANTLY BLACK INSTITUTIONS

(a) Purpose.--It is the purpose of this section to assist Predominantly Black Institutions in expanding educational opportunity through a program of Federal assistance.

(b) Definitions.--In this section:

(1) Eligible institution.--The term “eligible institution” means an institution of higher education that--

(A) has an enrollment of needy undergraduate students;

(B) has an average educational and general expenditure that is low, per full-time equivalent undergraduate student, in comparison with the average educational and general expenditure per full-time equivalent undergraduate student of institutions that offer similar instruction, except that the Secretary may apply the waiver requirements described in section 392(b) to this subparagraph in the same manner as the Secretary applies the waiver requirements to section 312(b)(1)(B);

(D) is legally authorized to provide, and provides, within the State an educational program for which the institution of higher education awards a baccalaureate degree or, in the case of a junior or community college, an associate's degree;

(E) is accredited by a nationally recognized accrediting agency or association determined by the Secretary to be a reliable authority as to the quality of training offered or is, according to such an agency or association, making reasonable progress toward accreditation; and

(F) is not receiving assistance under part B or part A of title V.

(2) Enrollment of needy students.--The term “enrollment of needy students” means the enrollment at an eligible institution with respect to which not less than 50 percent of the undergraduate students enrolled in an academic program leading to a degree--

(A) in the second fiscal year preceding the fiscal year for which the determination is made, were Federal Pell Grant recipients for such year;

(B) come from families that receive benefits under a means-tested Federal benefit program;

(i) is in the school district of a local educational agency that was eligible for assistance under part A of title I of the Elementary and Secondary Education Act of 1965 for any year during which the student attended such secondary school; and

(ii) for the purpose of this paragraph and for such year of attendance, was determined by the Secretary (pursuant to regulations and after consultation with the State educational agency of the State in which the school is located) to be a school in which the enrollment of children meeting a measure of poverty under section 1113(a)(5) of such Act exceeds 30 percent of the total enrollment of such school; or

(D) are first-generation college students and a majority of such first-generation college students are low-income individuals.

(3) First-generation college student.--The term “first-generation college student” has the meaning given the term in section 402A(h).*

(4) Low-income individual.--The term “low-income individual” has the meaning given such term in section 402A(h).**

(5) Means-tested federal benefit program.--The term `means-tested Federal benefit program' means a program of the Federal Government, other than a program under title IV, in which eligibility for the program's benefits, or the amount of such benefits, are determined on the basis of income or resources of the individual or family seeking the benefit.

(6) Predominantly black institution.--The term “Predominantly Black Institution” means an institution of higher education, as defined in section 101(a)--

(A) that is an eligible institution with not less than 1,000 undergraduate students;

(B) at which not less than 50 percent of the undergraduate students enrolled at the eligible institution are low-income individuals or first-generation college students; and

(C) at which not less than 50 percent of the undergraduate students are enrolled in an educational program leading to a bachelor's or associate's degree that the eligible institution is licensed to award by the State in which the eligible institution is located.

(7) State.--The term “State” means each of the 50 States and the District of Columbia.

(1) In general.--The Secretary is authorized to award grants, from allotments under subsection (e), to Predominantly Black Institutions to enable the Predominantly Black Institutions to carry out the authorized activities described in subsection (d).

(2) Priority.--In awarding grants under this section the Secretary shall give priority to Predominantly Black Institutions with large numbers or percentages of students described in subsections (b)(1)(A) or (b)(1)(C). The level of priority given to Predominantly Black Institutions with large numbers or percentages of students described in subsection (b)(1)(A) shall be twice the level of priority given to Predominantly Black Institutions with large numbers or percentages of students described in subsection (b)(1)(C).

(d) Authorized Activities.—

(1) Required activities.--Grant funds provided under this section shall be used--

(A) to assist the Predominantly Black Institution to plan, develop, undertake, and implement programs to enhance the institution's capacity to serve more low-and middle-income Black American students;

(B) to expand higher education opportunities for students eligible to participate in programs under title IV by encouraging college preparation and student persistence in secondary school and postsecondary education; and

(C) to strengthen the financial ability of the Predominantly Black Institution to serve the academic needs of the students described in subparagraphs (A) and (B).

(2) Additional activities.--Grant funds provided under this section shall be used for one or more of the following activities:

(A) The activities described in paragraphs (1) through (12) of section 311(c).***

(B) Academic instruction in disciplines in which Black Americans are underrepresented.

(C) Establishing or enhancing a program of teacher education designed to qualify students to teach in a public elementary school or secondary school in the State that shall include, as part of such program, preparation for teacher certification or licensure.

(D) Establishing community outreach programs that will encourage elementary school and secondary school students to develop the academic skills and the interest to pursue postsecondary education.

(E) Other activities proposed in the application submitted pursuant to subsection (f) that--

(i) contribute to carrying out the purpose of this section; and

(ii) are approved by the Secretary as part of the review and approval of an application submitted under subsection (f).

(3) Endowment fund.--

(A) In general.--A Predominantly Black Institution may use not more than 20 percent of the grant funds provided under this section to establish or increase an endowment fund at the institution.

(B) Matching requirement.--In order to be eligible to use grant funds in accordance with subparagraph (A), a Predominantly Black Institution shall provide matching funds from non-Federal sources, in an amount equal to or greater than the Federal funds used in accordance with subparagraph (A), for the establishment or increase of the endowment fund.

(C) Comparability.--The (NOTE: Applicability) provisions of part C, regarding the establishment or increase of an endowment fund, that the Secretary determines are not inconsistent with this subsection, shall apply to funds used under subparagraph (A).

(4) Limitation.--Not more than 50 percent of the grant funds provided to a Predominantly Black Institution under this section may be available for the purpose of constructing or maintaining a classroom, library, laboratory, or other instructional facility.

(e) Allotments to Predominantly Black Institutions.—

(1) Federal Pell grant basis.--From the amounts appropriated to carry out this section for any fiscal year, the Secretary shall allot to each Predominantly Black Institution having an application approved under subsection (f) a sum that bears the same ratio to one-half of that amount as the number of Federal Pell Grant recipients in attendance at such institution at the end of the academic year preceding the beginning of that fiscal year, bears to the total number of Federal Pell Grant recipients at all such institutions at the end of such academic year.

(2) Graduates basis.--From the amounts appropriated to carry out this section for any fiscal year, the Secretary shall allot to each Predominantly Black Institution having an application approved under subsection (f) a sum that bears the same ratio to one-fourth of that amount as the number of graduates for such academic year at such institution, bears to the total number of graduates for such academic year at all such institutions.

(3) Graduates seeking a higher degree basis.--From the amounts appropriated to carry out this section for any fiscal year, the Secretary shall allot to each Predominantly Black Institution having an application approved under subsection (f) a sum that bears the same ratio to one-fourth of that amount as the percentage of graduates from such institution who are admitted to and in attendance at, not later than two years after graduation with an associate's degree or a baccalaureate degree, a baccalaureate degree-granting institution or a graduate or professional school in a degree program in disciplines in which Black American students are underrepresented, bears to the percentage of such graduates for all such institutions.

(4) Minimum allotment.--

(A) In general.--Notwithstanding paragraphs (1), (2), and (3), the amount allotted to each Predominantly Black Institution under this section may not be less than $250,000.

(B) Insufficient amount.--If the amounts appropriated to carry out this section for a fiscal year are not sufficient to pay the minimum allotment provided under subparagraph (A) for the fiscal year, then the amount of such minimum allotment shall be ratably reduced. If additional sums become available for such fiscal year, such reduced allotment shall be increased on the same basis as the allotment was reduced until the amount allotted equals the minimum allotment required under subparagraph (A).

(5) Reallotment.--The amount of a Predominantly Black Institution's allotment under paragraph (1), (2), (3), or (4) for any fiscal year that the Secretary determines will not be needed for such institution for the period for which such allotment is available, shall be available for reallotment to other Predominantly Black Institutions in proportion to the original allotments to such other institutions under this section for such fiscal year. The Secretary shall reallot such amounts from time to time, on such date and during such period as the Secretary determines appropriate.

(f) Applications.--Each Predominantly Black Institution desiring a grant under this section shall submit an application to the Secretary at such time, in such manner, and containing or accompanied by such information as the Secretary may reasonably require.

(g) Application Review Process.--Section 393 shall not apply to applications under this section.

(h) Duration and Carryover.--Any grant funds paid to a Predominantly Black Institution under this section that are not expended or used for the purposes for which the funds were paid within ten years following the date on which the grant was awarded, shall be repaid to the Treasury.

(i) Special Rule on Eligibility.--No Predominantly Black Institution that receives funds under this section shall concurrently receive funds under any other provision of this part, part B, or part A of title V.

*First Generation College Student – For the purposes of this part, the term “first generation college student” means -

an individual both of whose parents did not complete a baccalaureate degree; or
in the case of any individual who regularly resided with and received support from one parent, an individual whose only such parent did not complete a baccalaureate degree.

**Low-Income Individual -For the purpose of this part, the term “low-income individual” means an individual from a family whose taxable income for the preceding year did not exceed 150 percent of an amount equal to the poverty level determined by using criteria of poverty established by the Bureau of the Census.

*** PART A STRENGTHENING INSTITUTIONS

(1) Purchase, rental, or lease of scientific or laboratory equipment for educational purposes, including instructional and research purposes.

(2) Construction, maintenance, renovation, and improvement in classrooms, libraries, laboratories, and other instructional facilities, including the integration of computer technology into institutional facilities to create smart buildings.

(3) Support of faculty exchanges, faculty development, and faculty fellowships to assist in attaining advanced degrees in the field of instruction of the faculty.

(4) Development and improvement of academic programs

(5) Purchase of library books, periodicals, and other educational materials, including telecommunications program material.

(6) Tutoring, counseling, and student service programs designed to improve academic success, including innovative, customized, instruction courses designed to help retain students and move the students rapidly into core courses and through program completion, which may include remedial education and English language instruction

(7) Education or counseling services designed to improve the financial literacy and economic literacy of students or the students' families.

(8) Funds management, administrative management, and acquisition of equipment for use in strengthening funds management.

(9) Joint use of facilities, such as laboratories and libraries.

(10) Establishing or improving a development office to strengthen or improve contributions from alumni and the private sector.

(11) Establishing or improving an endowment fund.

(12) Creating or improving facilities for Internet or other distance learning technologies, including purchase or rental of telecommunications technology equipment or services.

(13) Other activities proposed in the application submitted pursuant to subsection (b) and section 391 that-

(A) contribute to carrying out the purposes of the program assisted under this part; and

(B) are approved by the Secretary as part of the review and acceptance of such application.

NOTE: A Federal Register Notice is not needed for FY 2017. This office is reinstating this package in order to use the Phase I data form only for purposes of calculating the formula for continuation awards in FY 2017.

INSTRUCTIONS FOR COMPLETING THE APPLICATION

Part I. Formula Data

Part I of the application is the submission of information required for the Department to determine whether or not an institution qualifies as a PBI, and to calculate how much funding a PBI will receive, based on the formula established in the program legislation. The information will be submitted on this form which the applicant will submit to the program office at pbiprogram@ed.gov as an email attachment by TBD. In order to calculate how much all grantee institutions will receive, it is essential that Part I of the application, the Formula Data, be submitted on time. No calculations can be made until all PBIs have submitted the required information in full. Once determinations have been made, institutions will be informed whether or not they qualify as a PBI, and if so, the institution will also be notified of the amount it will receive. Applicants are strongly encouraged not to wait for this notification before beginning Part II of the application.

After completing and signing this form, please scan and email it (all three pages) to pbiprogram@ed.gov. If you do not have scanning capability, you may fax the signed copy to: Predominantly Black Institutions Program, Fax No. (202) 401-8466. THIS INFORMATION MUST BE SUBMITTED BY TBD.

L egal Name of Institution:

A ddress:

C ity: State: Zip:

Eligibility

The following information is required to determine whether or not your institution qualifies as a Predominantly Black Institution according to the program statute and is eligible for funding under this program.

What is your institution’s enrollment of needy students*? ___________________________
What was your institution’s average educational and general expenditure per full-time equivalent undergraduate student for the 2015-2016 academic year? _________________________________________________________
What was your institution’s undergraduate enrollment for the 2015-2016 academic year? ______________

For the 2015-2016 academic year, how many students in this undergraduate enrollment were:

3a. Low-income individuals*? _______________

3b. First generation college students*? ___________

3c. Black Americans? _______________

3d. Enrolled in an educational program at your institution leading to a bachelor’s or associate’s degree? _________________________

Is your institution receiving funding from another program under Title III, Parts A or B; or Title V; or authorized to receive an annual appropriation under the Act of March 2, 1867 (14 Stat. 438; 20 U.S.C. 123)? ___________________ If so, which program(s)? ______________________________________________________________
Is your institution currently accredited by a nationally recognized accrediting agency or association? ______________________________________________

*see page 7 for definition

Funding Formula Data

The formula has three elements. Applicants must submit accurate information on all three elements so that the awards may be calculated correctly.

Federal Pell Grant Basis

From the amounts appropriated to carry out this section for any fiscal year, the Secretary of Education must allot to each Predominantly Black Institution having an application approved by the Department of Education a sum that bears the same ratio to one-half of that amount as the number of Federal Pell Grant recipients in attendance at such institution at the end of the academic year preceding the beginning of that fiscal year, bears to the total number of Federal Pell Grant recipients at all such institutions at the end of such academic year.

Please submit the number of Pell Grant recipients in attendance at your institution at the end of academic year (AY) 2015-2016: _______________________________

Graduates Basis

2015

2016

Totals (2015+2016)

Total Number of Graduates from Undergraduate Class:

_________________

Number of Graduates of Your Institution Admitted to and in Attendance at a Baccalaureate degree-granting institution or a Graduate or Professional School in a Degree Program in Disciplines in which Black American Students are

Underrepresented:

_________________

Graduates Seeking a Higher Degree Basis

From the amounts appropriated to carry out this section for any fiscal year, the Secretary of Education must allot to each Predominantly Black Institution having an application approved by the Department of Education a sum that bears the same ratio to one-fourth of that amount as the percentage of graduates from such institution who are admitted to and in attendance at, not later than two years after graduation with an associate's degree or a baccalaureate degree, a baccalaureate degree-granting institution or a graduate or professional school in a degree program in disciplines in which Black American students are underrepresented, bears to the percentage of such graduates for all such institutions.

Signature

I attest to the accuracy of the data presented on this form.

Name of Institutional Representative (printed or typed):

Signature of Institutional Representative:

Date:

Part II. Project Plan

Part II of the application is the Project Plan. The deadline for transmittal of Part II of the application is TBD. Part II of the application must be submitted with Part III of the application as an e-mail attachment to pbiprogram@ed.gov.

Abstract: Applicants must provide a one-page overview of the project and planned activities, demonstrating how the project will enhance the institution’s capacity to serve more low- and middle-income Black American students.

Project Narrative: Applicants must provide a project narrative of no more than 50 pages that describes how the institution will strengthen its ability to enhance higher education opportunities for low-income and Black American students. The narrative should address the following key topics:

Need for the Project: Please give a comprehensive analysis of your institution’s strengths and weaknesses, and describe how specific weaknesses in services, infrastructure, or opportunities will be addressed by the proposed project. Please describe how the proposed project directly relates to the purpose of the PBI program, and will improve the institution’s capacity to serve its target student populations.
Project Design: Please describe the goals and objectives of the proposed project, the activities that will address these goals and objectives, and an implementation plan for each activity. Please describe how the activities will result in clearly defined and measurable project outcomes. Where applicable, please include an explanation of how each activity in the proposed project reflects up-to-date knowledge from research and effective practice.
Project Services: Please describe how the services provided by the proposed project are appropriate to the needs of the intended recipients, the likely impact of the project services on the intended recipients, and how the services are of sufficient quality, intensity and duration to lead to improvements in practice of the recipients.
Project Personnel: Please describe the qualifications, including relevant training and experience, of the project director and other key personnel.
Resources: Please describe the level of commitment by the institution’s management and key stakeholders to supporting the activities of the proposed project and achieving the goals and objectives of the project and the program.
Management Plan: Please describe the management plan for the proposed project, and how it will ensure that the goals and objectives are achieved on time and within the budget, including clearly defined responsibilities, timelines and milestones for accomplishing project tasks. Please also describe the procedures for ensuring feedback and continuous improvement in the operation of the proposed project, and the mechanisms for ensuring high-quality products and services.
Evaluation Plan: Please describe the ways in which the methods of evaluation: are thorough, feasible and appropriate to the goals, objectives and outcomes of the proposed project; include the use of objective performance measures that are clearly related to the intended outcomes and will produce quantitative and qualitative data; provide for examining the effectiveness of project implementation strategies; and will provide feedback and permit periodic assessment of progress toward achieving intended outcomes.

NOTE: The 50 page limit applies to the Project Narrative only. It does not apply to the Goals and Objectives Form or the Budget Summary or Narrative forms.

Goals and Objectives Form: For purposes of project evaluation, please complete the Goals and Objectives Form on page 22. Identify all of the allowable activities listed in the statute and on page 8 of this booklet for which the institution will use grant funds, the goals or objectives to be addressed by each activity, related baseline data, and a measurable outcome, including quantitative target data, developed to evaluate success. Use the example provided on the form for guidance.

Allowable Activities - these are on page 8 of this application, as well as in the program legislation, Title III, Part A, Sec. 318(d).
Goals and Objectives - institutional goals and objectives to be achieved using PBI funding should correspond to an allowable activity. If there is more than one objective for a given activity, enter only one project objective per row and please number the goals and objectives within each activity. Example: the first project goal or objective associated with an allowable activity should be numbered “1,” the second should be numbered “2,” etc.
Performance Indicators/Measures Addressed - For each project objective, enter each associated performance measure. These might be program performance measures, as listed on page 45 or they may be institutional or project-specific performance indicators developed by the institution. If there are multiple performance measures associated with a project objective, enter only one performance measure per row and please label each measure using a numerical and an alpha indicator. Example: the first performance measure associated with project objective “1” should be labeled “1.a.,” the second performance measure for project objective “1” should be labeled “1.b.,” etc.
Baseline Data - Provide the baseline data for each performance measure. If baseline data is not available for a performance measure, please use an estimate.
Proposed Outcomes/Target Data - Provide the target data that the institution has established for meeting each performance measure. Every applicant is expected to set targets for each budget period of the grant.*

Note: If the collection of quantitative data is not appropriate for a particular performance measure, please provide any relevant qualitative data for the performance measure. If necessary, attach a narrative page to the form.

Budget Period - For each objective, please provide the budget period in which this objective will be accomplished. If the objective will be achieved over more than one budget period, please indicate this.

*If necessary, ED may approve revised target data for a performance measure at a future date.

Budget Form and Narrative: Please complete Budget Form 524 and the accompanying Budget Narrative (see pages 34 –35) in Part III of the application. Please address all budget periods within the project period. Please include in the Budget Narrative all activities for which you are requesting funding, placing them in the appropriate Budget Categories, and provide a detailed breakdown of the costs associated with each activity.

Goals and Objectives Form
Please provide a detailed description of the activities to be supported using program funding: please reference the allowable activity as stated in the program legislation, measurable goals and objectives within the scope of these activities; associated performance indicators/measures; baseline data; proposed outcomes, including quantitative target data, to be used to evaluate the success of the funded activities; and the budget period(s) in which the objectives will be achieved. Please make sure that the information on this form reflects the goals, activities and outcomes described in your Project Narrative, especially your Evaluation Plan.

Allowable Activities	Goals and Objectives	Performance Indicators/Measures Addressed	Baseline Data	Proposed Outcomes/Target Data	Budget Period*
Example: #3 Purchase of library books, periodicals, technical and other scientific journals, microfilm, microfiche, and other educational materials, including telecommunications and program materials.	1. Increase and expand the university library's collection of books and periodicals related to economics.	N/A	University library currently maintains an economics collection of 150 books and two periodicals.	Increase university library economics collection to 350 books and 5 periodicals.	3
	2. Etc.	2.a.
		2.b.







* Budget Periods: 1 = Academic Year 2016-2017, 2 = Academic Year 2017-2018, 3 = Academic Year 2018-2019, 4 = Academic Year 2019-2020, 5 = Academic Year 2020-2021

PART III. STANDARD FORMS AND CERTIFICATIONS

Part III of the application, which includes the standard forms and certifications, must be submitted with Phase II of the application, the Project Plan, by TBD. Part III of the application must be submitted as an e-mail attachment to pbiprogram@ed.gov. The signed copies of the standard forms may be scanned and submitted via email, or faxed to: Predominantly Black Institutions Program, fax number (202) 401-8466.

OMB Number: 4040-0004

Expiration Date: 10/31/2019

Application for Federal Assistance SF-424
* 1. Type of Submission: Preapplication Application Changed/Corrected Application	* 2. Type of Application: New Continuation Revision			* If Revision, select appropriate letter(s):
				*Other (Specify):
* Completed by Grants.gov upon submission 3. Date Received: 4. Applicant Identifier:
5a. Federal Entity Identifier:			*5b. Federal Award Identifier:
State Use Only:
6. Date Received by State:		7. State Application Identifier:
8. APPLICANT INFORMATION:
* a. Legal Name:
* b. Employer/Taxpayer Identification Number (EIN/TIN):			* c. Organizational DUNS:
d. Address:
* Street 1:
Street 2:
* City:
County/Parish:
*State:
Province:
*Country:
* Zip / Postal Code:
e. Organizational Unit:
Department Name:			Division Name:
f. Name and contact information of person to be contacted on matters involving this application:
P refix: *First Name:
Middle Name:
* Last Name:
Suffix:
Title:
Organizational Affiliation:
*Telephone Number: Fax Number:
*Email:
Application for Federal Assistance SF-424
9 . Type of Applicant 1: Select Applicant Type:
Type of Applicant 2: Select Applicant Type:
Type of Applicant 3: Select Applicant Type:
*Other (Specify)
* 10 Name of Federal Agency:
11. Catalog of Federal Domestic Assistance Number: CFDA Title:
* 12 Funding Opportunity Number: * Title:
13. Competition Identification Number: Title:
14. Areas Affected by Project (Cities, Counties, States, etc.):
* 15. Descriptive Title of Applicant’s Project: Attach supporting documents as specified in agency instructions.

Application for Federal Assistance SF-424
1 6. Congressional Districts Of: a. Applicant: b. Program/Project:
Attach an additional list of Program/Project Congressional Districts if needed.
1 7. Proposed Project: a. Start Date: b. End Date:
18. Estimated Funding ($):
* a. Federal * b. Applicant * c. State * d. Local * e. Other * f. Program Income *g. TOTAL






* 19. Is Application Subject to Review By State Under Executive Order 12372 Process? a. This application was made available to the State under the Executive Order 12372 Process for review on b. Program is subject to E.O. 12372 but has not been selected by the State for review. c. Program is not covered by E.O. 12372.
* 20. Is the Applicant Delinquent On Any Federal Debt? (If “Yes,” provide explanation in attachment.) Yes No If “Yes”, provide explanation and attach.
2 1. 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 certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions.
Authorized Representative:
P refix: First Name: M iddle Name: Last Name: Suffix:
* Title:
* Telephone Number:	Fax Number:
* Email:
* Signature of Authorized Representative:		* Date Signed:

INSTRUCTIONS FOR THE SF-424

This is a standard form required for use as a cover sheet for submission of pre-applications 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 fields on the form are identified with an asterisk (*) and are also specified as “Required” in the instructions below. In addition to these instructions, applicants must consult agency instructions to determine other specific requirements.

Item	Entry:		Item:	Entry:
1.	Type of Submission: (Required) Select one type of submission in accordance with agency instructions. • Pre-application • Application • Changed/Corrected Application – Check if this submission is to change or correct a previously submitted application. Unless requested by the agency, applicants may not use this form to submit changes after the closing date.		10.	Name Of Federal Agency: (Required) Enter the name of the federal agency from which assistance is being requested with this application.
			11.	Catalog Of Federal Domestic Assistance Number/Title: 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.
2.	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 renewals. • 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 D. Decrease Duration B. Decrease Award E. Other (specify) C. Increase Duration		12.	Funding Opportunity Number/Title: (Required) Enter the Funding Opportunity Number (FON) and title of the opportunity under which assistance is requested, as found in the program announcement.
			13.	Competition Identification Number/Title: Enter the competition identification number and title of the competition under which assistance is requested, if applicable.
			14.	Areas Affected By Project: This data element is intended for use only by programs for which the area(s) affected are likely to be different than the place(s) of performance reported on the SF-424 Project/Performance Site Location(s) Form. Add attachment to enter additional areas, if needed.
3.	Date Received: Leave this field blank. This date will be assigned by the Federal agency.		15.	Descriptive Title of Applicant’s Project: (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 pre-applications, attach a summary description of the project.
4.	Applicant Identifier: Enter the entity identifier assigned buy 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.		16.	Congressional Districts Of: 16a. (Required) Enter the applicant’s congressional district. 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 12 district, NC-103 for North Carolina’s 103 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 00-000. This optional data element is intended for use only by programs for which the area(s) affected are likely to be different than place(s) of performance reported on the SF-424 Project/Performance Site Location(s) Form. Attach an additional list of program/project congressional districts, if needed.
5b.	Federal Award Identifier: For new applications, enter NA. 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.	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.	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 (CCR). Information on registering with CCR may be obtained by visiting www.Grants.gov.		17.	Proposed Project Start and End Dates: (Required) Enter the proposed start date and end date of the project.
	b. Employer/Taxpayer Number (EIN/TIN): (Required) Enter the employer or taxpayer identification number (EIN or TIN) as assigned by the Internal Revenue Service. If your organization is not in the US, enter 44-4444444.		18.	Estimated Funding: (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.
	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 www.Grants.gov.		19.	Is Application Subject to Review by State Under Executive Order 12372 Process? (Required) 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.
	d. Address: Enter address: Street 1 (Required); city (Required); County/Parish, State (Required if country is US), Province, Country (Required), 9-digit zip/postal code (Required if country US).		20.	Is the Applicant Delinquent on any Federal Debt? (Required) Select the appropriate box. This question applies to the applicant organization, not the person who signs as the authorized representative. Categories of federal debt include; but, may not be limited to: delinquent audit disallowances, loans and taxes. If yes, include an explanation in an attachment.
	e. Organizational Unit: Enter the name of the primary organizational unit, department or division that will undertake the assistance activity.		21.	Authorized Representative: To be signed and dated by the authorized representative of the applicant organization. Enter the first and last name (Required); prefix, middle name, suffix. Enter title, telephone number, email (Required); and fax number. 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.)
	f. Name and contact information of person to be contacted on matters involving this application: Enter the first and last name (Required); prefix, middle name, suffix, title. Enter organizational affiliation if affiliated with an organization other than that in 7.a. Telephone number and email (Required); fax number.
9.	Type of Applicant: (Required) Select up to three applicant type(s) in accordance with agency instructions.
	A. State Government B. County Government C. City or Township Government D. Special District Government E. Regional Organization F. U.S. Territory or Possession G. Independent School District H. Public/State Controlled Institution of Higher Education 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/Indian Housing Authority	M. Nonprofit N. Private Institution of Higher Education O. Individual P. For-Profit Organization (Other than Small Business) Q. Small Business R. Hispanic-serving Institution S. Historically Black Colleges and Universities (HBCUs) T. Tribally Controlled Colleges and Universities (TCCUs) U. Alaska Native and Native Hawaiian Serving Institutions V. Non-US Entity W. Other (specify)

[U.S Department of Education note: As of spring, 2010, the FON discussed in Block 12 of the instructions can be found via the following URL: http://www.grants.gov/applicants/find_grant_opportunities.jsp.]

SUPPLEMENTAL INFORMATION

REQUIRED FOR

DEPARTMENT OF EDUCATION

1. Project Director:

Prefix: *First Name: Middle Name: *Last Name: Suffix:

Address:

Street1:

treet2:

City:

ounty:

State * Zip Code: * Country:

* Phone Number (give area code) Fax Number (give area code)

Email Address:

2. Applicant Experience:

Novice Applicant Yes No Not applicable to this program

3. Human Subjects Research:

Are any research activities involving human subjects planned at any time during the proposed project period?

Yes No

Are ALL the research activities proposed designated to be exempt from the regulations?

Yes Provide Exemption(s) #:

No Provide Assurance #, if available:

Please attach an explanation Narrative:

OMB Control No. 1894-0007

Expiration Date: 08/31/2017

INSTRUCTIONS FOR

DEPARTMENT OF EDUCATION SUPPLEMENTAL INFORMATION FOR SF 424

Project Director. Name, address, telephone and fax numbers, and e-mail address of the person to be contacted on matters involving this application.

2. Novice Applicant. Check “Yes” or “No” only if assistance is being requested under a program that gives special consideration to novice applicants. Otherwise, leave blank.

Check “Yes” if you meet the requirements for novice applicants specified in the regulations in 34 CFR 75.225 and included on the attached page entitled “Definitions for Department of Education Supplemental Information for SF 424.” By checking “Yes” the applicant certifies that it meets these novice applicant requirements. Check “No” if you do not meet the requirements for novice applicants.

3. Human Subjects Research. (See I. A. “Definitions” in attached page entitled “Definitions for Department of Education Supplemental Information For SF 424.”)

If Not Human Subjects Research. Check “No” if research activities involving human subjects are not planned at any time during the proposed project period. The remaining parts of Item 3 are then not applicable.

If Human Subjects Research. Check “Yes” if research activities involving human subjects are planned at any time during the proposed project period, either at the applicant organization or at any other performance site or collaborating institution. Check “Yes” even if the research is exempt from the regulations for the protection of human subjects. (See I. B. “Exemptions” in attached page entitled “Definitions for Department of Education Supplemental Information For SF 424.”)

3a. If Human Subjects Research is Exempt from the Human Subjects Regulations. Check “Yes” if all the research activities proposed are designated to be exempt from the regulations. Insert the exemption number(s) corresponding to one or more of the six exemption categories listed in I. B. “Exemptions.” In addition, follow the instructions in II. A. “Exempt Research Narrative” in the attached page entitled “Definitions for Department of Education Supplemental Information For SF 424.”

3a. If Human Subjects Research is Not Exempt from Human Subjects Regulations. Check “No” if some or all of the planned research activities are covered (not exempt). In addition, follow the instructions in II. B. “Nonexempt Research Narrative” in the page entitled “Definitions for Department of Education Supplemental Information For SF 424

3a. Human Subjects Assurance Number. If the applicant has an approved Federal Wide (FWA) on file with the Office for Human Research Protections (OHRP), U.S. Department of Health and Human Services, that covers the specific activity, insert the number in the space provided. If the applicant does not have an approved assurance on file with OHRP, enter “None.” In this case, the applicant, by signature on the SF-424, is declaring that it will comply with 34 CFR 97 and proceed to obtain the human subjects assurance upon request by the designated ED official. If the application is recommended/selected for funding, the designated ED official will request that the applicant obtain the assurance within 30 days after the specific formal request.

Note about Institutional Review Board Approval. ED does not require certification of Institutional Review Board approval with the application. However, if an application that involves non-exempt human subjects research is recommended/selected for funding, the designated ED official will request that the applicant obtain and send the certification to ED within 30 days after the formal request.

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 1894-0007. The time required to complete this information collection is estimated to average between 15 and 45 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 of the estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, 400 Maryland Avenue, S.W., Washington, D.C. 20202-4537. If you have comments or concerns regarding the status of your individual submission of this form write directly to: Application Control Center, U.S. Department of Education, Potomac Center Plaza, 550 12^th Street, S.W. Room 7076, Washington, D.C. 20202-4260.

DEFINITIONS FOR

DEPARTMENT OF EDUCATION SUPPLEMENTAL INFORMATION FOR SF 424

(Attachment to Instructions for Supplemental Information for SF 424)

Definitions:

Novice Applicant (See 34 CFR 75.225). For discretionary grant programs under which the Secretary gives special consideration to novice applications, a novice applicant means any applicant for a grant from ED that—

Has never received a grant or subgrant under the program from which it seeks funding;

Has never been a member of a group application, submitted in accordance with 34 CFR 75.127-75.129, that received a grant under the program from which it seeks funding; and

Has not had an active discretionary grant from the Federal government in the five years before the deadline date for applications under the program. For the purposes of this requirement, a grant is active until the end of the grant’s project or funding period, including any extensions of those periods that extend the grantee’s authority to obligate funds.

In the case of a group application submitted in accordance with 34 CFR 75.127-75.129, a group includes only parties that meet the requirements listed above.

PROTECTION OF HUMAN SUBJECTS IN RESEARCH

I. Definitions and Exemptions

A. Definitions.

A research activity involves human subjects if the activity is research, as defined in the Department’s regulations, and the research activity will involve use of human subjects, as defined in the regulations.

—Research

The ED Regulations for the Protection of Human Subjects, Title 34, Code of Federal Regulations, Part 97, define research as “a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge.” If an activity follows a deliberate plan whose purpose is to develop or contribute to generalizable knowledge it is research. Activities which meet this definition constitute research whether or not they are conducted or supported under a program that is considered research for other purposes. For example, some demonstration and service programs may include research activities.

—Human Subject

The regulations define human subject as “a living individual about whom an investigator (whether professional or student) conducting research obtains (1) data through intervention or interaction with the individual, or (2) identifiable private information.” (1) If an activity involves obtaining information about a living person by manipulating that person or that person’s environment, as might occur when a new instructional technique is tested, or by communicating or interacting with the individual, as occurs with surveys and interviews, the definition of human subject is met. (2) If an activity involves obtaining private information about a living person in such a way that the information can be linked to that individual (the identity of the subject is or may be readily determined by the investigator or associated with the information), the definition of human subject is met. [Private information includes information about behavior that occurs in a context in which an individual can reasonably expect that no observation or recording is taking place, and information which has been provided for specific purposes by an individual and which the individual can reasonably expect will not be made public (for example, a school health record).]

B. Exemptions.

Research activities in which the only involvement of human subjects will be in one or more of the following six categories of exemptions are not covered by the regulations:

(1) Research conducted in established or commonly accepted educational settings, involving normal educational practices, such as (a) research on regular and special education instructional strategies, or (b) research on the effectiveness of or the comparison among instructional techniques, curricula, or classroom management methods.

(2) Research involving the use of educational tests (cognitive, diagnostic, aptitude, achievement), survey procedures, interview procedures or observation of public behavior, unless: (a) information obtained is recorded in such a manner that human subjects can be identified, directly or through identifiers linked to the subjects; and (b) any disclosure of the human subjects’ responses outside the research could reasonably place the subjects at risk of criminal or civil liability or be damaging to the subjects’ financial standing, employability, or reputation. If the subjects are children, exemption 2 applies only to research involving educational tests and observations of public behavior when the investigator(s) do not participate in the activities being observed.

Exemption 2 does not apply if children are surveyed or interviewed or if the research involves observation of public behavior and the investigator(s) participate in the activities being observed. [Children are defined as persons who have not attained the legal age for consent to treatments or procedures involved in the research, under the applicable law or jurisdiction in which the research will be conducted.]

(3) Research involving the use of educational tests (cognitive, diagnostic, aptitude, achievement), survey procedures, interview procedures or observation of public behavior that is not exempt under section (2) above, if the human subjects are elected or appointed public officials or candidates for public office; or federal statute(s) require(s) without exception that the confidentiality of the personally identifiable information will be maintained throughout the research and thereafter.

(4) Research involving the collection or study of existing data, documents, records, pathological specimens, or diagnostic specimens, if these sources are publicly available or if the information is recorded by the investigator in a manner that subjects cannot be identified, directly or through identifiers linked to the subjects.

(5) Research and demonstration projects which are conducted by or subject to the approval of department or agency heads, and which are designed to study, evaluate, or otherwise examine: (a) public benefit or service programs; (b) procedures for obtaining benefits or services under those programs; (c) possible changes in or alternatives to those programs or procedures; or (d) possible changes in methods or levels of payment for benefits or services under those programs.

(6) Taste and food quality evaluation and consumer acceptance studies, (a) if wholesome foods without additives are consumed or (b) if a food is consumed that contains a food ingredient at or below the level and for a use found to be safe, or agricultural chemical or environmental contaminant at or below the level found to be safe, by the Food and Drug Administration or approved by the Environmental Protection Agency or the Food Safety and Inspection Service of the U.S. Department of Agriculture.

II. Instructions for Exempt and Nonexempt Human Subjects Research Narratives

If the applicant marked “Yes” for Item 3 of Department of Education Supplemental Information for SF 424, the applicant must provide a human subjects “exempt research” or “nonexempt research” narrative. Insert the narrative(s) in the space provided. If you have multiple projects and need to provide more than one narrative, be sure to label each set of responses as to the project they address.

A. Exempt Research Narrative.

If you marked “Yes” for item 3 a. and designated exemption numbers(s), provide the “exempt research” narrative. The narrative must contain sufficient information about the involvement of human subjects in the proposed research to allow a determination by ED that the designated exemption(s) are appropriate. The narrative must be succinct.

B. Nonexempt Research Narrative.

If you marked “No” for item 3 a. you must provide the “nonexempt research” narrative. The narrative must address the following seven points. Although no specific page limitation applies to this section of the application, be succinct.

(1) Human Subjects Involvement and Characteristics: Provide a detailed description of the proposed involvement of human subjects. Describe the characteristics of the subject population, including their anticipated number, age range, and health status. Identify the criteria for inclusion or exclusion of any subpopulation. Explain the rationale for the involvement of special classes of subjects, such as children, children with disabilities, adults with disabilities, persons with mental disabilities, pregnant women, prisoners, institutionalized individuals, or others who are likely to be vulnerable

(2) Sources of Materials: Identify the sources of research material obtained from individually identifiable living human subjects in the form of specimens, records, or data. Indicate whether the material or data will be obtained specifically for research purposes or whether use will be made of existing specimens, records, or data.

(3) Recruitment and Informed Consent: Describe plans for the recruitment of subjects and the consent procedures to be followed. Include the circumstances under which consent will be sought and obtained, who will seek it, the nature of the information to be provided to prospective subjects, and the method of documenting consent. State if the Institutional Review Board (IRB) has authorized a modification or waiver of the elements of consent or the requirement for documentation of consent.

(4) Potential Risks: Describe potential risks (physical, psychological, social, legal, or other) and assess their likelihood and seriousness. Where appropriate, describe alternative treatments and procedures that might be advantageous to the subjects.

(5) Protection Against Risk: Describe the procedures for protecting against or minimizing potential risks, including risks to confidentiality, and assess their likely effectiveness. Where appropriate, discuss provisions for ensuring necessary medical or professional intervention in the event of adverse effects to the subjects. Also, where appropriate, describe the provisions for monitoring the data collected to ensure the safety of the subjects.

(6) Importance of the Knowledge to be Gained: Discuss the importance of the knowledge gained or to be gained as a result of the proposed research. Discuss why the risks to subjects are reasonable in relation to the anticipated benefits to subjects and in relation to the importance of the knowledge that may reasonably be expected to result.

(7) Collaborating Site(s): If research involving human subjects will take place at collaborating site(s) or other performance site(s), name the sites and briefly describe their involvement or role in the research.

Copies of the Department of Education’s Regulations for the Protection of Human Subjects, 34 CFR Part 97 and other pertinent materials on the protection of human subjects in research are available from the U.S. Department of Education, Protection of Human Subjects Coordinator, Office of the Chief Financial Officer, LBJ Building, 400 Maryland Avenue, SW, Washington, D.C. 20202-4250, telephone: (202) 260-3353, and on the U.S. Department of Education’s Protection of Human Subjects in Research Web Site: http://www.ed.gov/about/offices/list/ocfo/humansub.html

NOTE: The State Applicant Identifier on the SF 424 is for State Use only. Please complete it on the OMB Standard 424 in the upper right corner of the form (if applicable).

U.S. DEPARTMENT OF EDUCATION

BUDGET INFORMATION

NON-CONSTRUCTION PROGRAMS

OMB Control Number: 1894-0008

Expiration Date:

06/30/2017

Name of Institution/Organization

Applicants requesting funding for only one year should complete the column under "Project Year 1." Applicants requesting funding for multi-year grants should complete all applicable columns. Please read all instructions before completing form.

SECTION A - BUDGET SUMMARY

U.S. DEPARTMENT OF EDUCATION FUNDS

Budget Categories

Project Year 1

(a)

Project Year 2

(b)

Project Year 3

(c)

Project Year 4

(d)

Project Year 5

(e)

Total

(f)

1. Personnel

2. Fringe Benefits

3. Travel

4. Equipment

5. Supplies

6. Contractual

7. Construction

8. Other

9. Total Direct Costs (lines 1-8)

10. Indirect Costs*

11. Training Stipends

12. Total Costs (lines 9-11)

*Indirect Cost Information (To Be Completed by Your Business Office):

If you are requesting reimbursement for indirect costs on line 10, please answer the following questions:

Do you have an Indirect Cost Rate Agreement approved by the Federal government? ____Yes ____ No
If yes, please provide the following information:

Period Covered by the Indirect Cost Rate Agreement: From: ___/___/______ To: ___/___/______ (mm/dd/yyyy)

Approving Federal agency: ____ ED ____ Other (please specify): __________________________ The Indirect Cost Rate is _________%

For Restricted Rate Programs (check one) -- Are you using a restricted indirect cost rate that:

___ Is included in your approved Indirect Cost Rate Agreement? or ___ Complies with 34 CFR 76.564(c)(2)? The Restricted Indirect Cost Rate is _________%

ED 524

Name of Institution/Organization			Applicants requesting funding for only one year should complete the column under "Project Year 1." Applicants requesting funding for multi-year grants should complete all applicable columns. Please read all instructions before completing form.
SECTION B - BUDGET SUMMARY NON-FEDERAL FUNDS
Budget Categories	Project Year 1 (a)	Project Year 2 (b)	Project Year 3 (c)	Project Year 4 (d)	Project Year 5 (e)	Total (f)

1. Personnel
2. Fringe Benefits
3. Travel
4. Equipment
5. Supplies
6. Contractual
7. Construction
8. Other
9. Total Direct Costs (Lines 1-8)
10. Indirect Costs
11. Training Stipends
12. Total Costs (Lines 9-11)
SECTION C – BUDGET NARRATIVE (see instructions)

General Instructions

This form is used to apply to individual U.S. Department of Education (ED) discretionary grant programs. Unless directed otherwise, provide the same budget information for each year of the multi-year funding request. Pay attention to applicable program specific instructions, if attached. You may access the Education Department General Administrative Regulations, 34 CFR 74 – 86 and 97-99, on ED’s website at:

http://www.ed.gov/policy/fund/reg/edgarReg/edgar.html

You must consult with your Business Office prior to submitting this form.

Section A - Budget Summary

U.S. Department of Education Funds

All applicants must complete Section A and provide a break-down by the applicable budget categories shown in lines 1-11.

Lines 1-11, columns (a)-(e): For each project year for which funding is requested, show the total amount requested for each applicable budget category.

Lines 1-11, column (f): Show the multi-year total for each budget category. If funding is requested for only one project year, leave this column blank.

Line 12, columns (a)-(e): Show the total budget request for each project year for which funding is requested.

Line 12, column (f): Show the total amount requested for all project years. If funding is requested for only one year, leave this space blank.

Indirect Cost Information: If you are requesting reimbursement for indirect costs on line 10, this information is to be completed by your Business Office. (1): Indicate whether or not your organization has an Indirect Cost Rate Agreement that was approved by the Federal government.

If you checked “no,” ED generally will authorize grantees to use a temporary rate of 10 percent of budgeted salaries and wages subject to the following limitations:

(a) The grantee must submit an indirect cost proposal to its cognizant agency within 90 days after ED issues a grant award notification; and

(b) If after the 90-day period, the grantee has not submitted an indirect cost proposal to its cognizant agency, the grantee may not charge its grant for indirect costs until it has negotiated an indirect cost rate agreement with its cognizant agency.

(2): If you checked “yes” in (1), indicate in (2) the beginning and ending dates covered by the Indirect Cost Rate Agreement. In addition, indicate whether ED, another Federal agency (Other) or State agency issued the approved agreement. If you check “Other,” specify the name of the Federal or other agency that issued the approved agreement.

(3): If you are applying for a grant under a Restricted Rate Program (34 CFR 75.563 or 76.563), indicate whether you are using a restricted indirect cost rate that is included on your approved Indirect Cost Rate Agreement or whether you are using a restricted indirect cost rate that complies with 34 CFR 76.564(c)(2). Note: State or Local government agencies may not use the provision for a restricted indirect cost rate specified in 34 CFR 76.564(c)(2). Check only one response. Leave blank, if this item is not applicable.

Section B - Budget Summary

Non-Federal Funds

If you are required to provide or volunteer to provide cost-sharing or matching funds or other non-Federal resources to the project, these should be shown for each applicable budget category on lines 1‑11 of Section B.

Lines 1-11, columns (a)-(e): For each project year, for which matching funds or other contributions are provided, show the total contribution for each applicable budget category.

Lines 1-11, column (f): Show the multi-year total for each budget category. If non-Federal contributions are provided for only one year, leave this column blank.

Line 12, columns (a)-(e): Show the total matching or other contribution for each project year.

Line 12, column (f): Show the total amount to be contributed for all years of the multi-year project. If non-Federal contributions are provided for only one year, leave this space blank.

Section C - Budget Narrative [Attach separate sheet(s)]

Pay attention to applicable program specific instructions,
if attached.

Provide an itemized budget breakdown, and justification by project year, for each budget category listed in Sections A and B. For grant projects that will be divided into two or more separately budgeted major activities or sub-projects, show for each budget category of a project year the breakdown of the specific expenses attributable to each sub-project or activity.

For non-Federal funds or resources listed in Section B that are used to meet a cost-sharing or matching requirement or provided as a voluntary cost-sharing or matching commitment, you must include:

a. The specific costs or contributions by budget category;

b. The source of the costs or contributions; and

c. In the case of third-party in-kind contributions, a description of how the value was determined for the donated or contributed goods or services.

[Please review ED’s general cost sharing and matching regulations, which include specific limitations, in 34 CFR 74.23, applicable to non-governmental entities, and 80.24, applicable to governments, and the applicable Office of Management and Budget (OMB) cost principles for your entity type regarding donations, capital assets, depreciation and use allowances. OMB cost principle circulars are available on OMB’s website at: http://www.whitehouse.gov/omb/circulars/index.html]

If applicable to this program, provide the rate and base on which fringe benefits are calculated.

If you are requesting reimbursement for indirect costs on line 10, this information is to be completed by your Business Office. Specify the estimated amount of the base to which the indirect cost rate is applied and the total indirect expense. Depending on the grant program to which you are applying and/or your approved Indirect Cost Rate Agreement, some direct cost budget categories in your grant application budget may not be included in the base and multiplied by your indirect cost rate. For example, you must multiply the indirect cost rates of “Training grants" (34 CFR 75.562) and grants under programs with “Supplement not Supplant” requirements ("Restricted Rate" programs) by a “modified total direct cost” (MTDC) base (34 CFR 75.563 or 76.563). Please indicate which costs are included and which costs are excluded from the base to which the indirect cost rate is applied.

When calculating indirect costs (line 10) for "Training grants" or grants under "Restricted Rate" programs, you must refer to the information and examples on ED’s website at: http://www.ed.gov/fund/grant/apply/appforms/appforms.html.

You may also contact (202) 377-3838 for additional information regarding calculating indirect cost rates or general indirect cost rate information.

Provide other explanations or comments you deem necessary.

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 1894-0008. The time required to complete this information collection is estimated to vary from 13 to 22 hours per response, with an average of 17.5 hours per response, including the time to review instructions, search existing data sources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4537. If you have comments or concerns regarding the status of your individual submission of this form, write directly to (insert program office), U.S. Department of Education, 400 Maryland Avenue, S.W., Washington, D.C. 20202.

OMB Approval No. 0348-0040

ASSURANCES - NON-CONSTRUCTION PROGRAMS

Public reporting burden for this collection of information is estimated to average 15 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 (0348-0040), Washington, DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the

awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such

is the case, you will be notified.

As the duly authorized representative of the applicant, I certify that the applicant:

1.Has the legal authority to apply for Federal assistance

and the institutional, managerial and financial capability

(including funds sufficient to pay the non-Federal share

of project cost) to ensure proper planning, management

and completion of the project described in this

application.

2. Will give the awarding agency, the Comptroller General

of the United States and, if appropriate, the State,

through any authorized representative, access to and

the right to examine all records, books, papers, or

documents related to the award; and will establish a

proper accounting system in accordance with generally

accepted accounting standards or agency directives.

3.Will establish safeguards to prohibit employees from

using their positions for a purpose that constitutes or

presents the appearance of personal or organizational

conflict of interest, or personal gain.

4.Will initiate and complete the work within the applicable

time frame after receipt of approval of the awarding

agency.

5. /Will comply with the Intergovernmental Personnel Act of

1970 (42 U.S.C. §§4728-4763) relating to prescribed

standards for merit systems for programs funded under

one of the 19 statutes or regulations specified in

Appendix A of OPM's Standards for a Merit System of

Personnel Administration (5 C.F.R. 900, Subpart F).

6.Will comply with all Federal statutes relating to

nondiscrimination. These include but are not limited to:

(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)

which prohibits discrimination on the basis of race, color

or national origin; (b) Title IX of the Education

Amendments of 1972, as amended (20 U.S.C. §§1681-

1683, and 1685-1686), which prohibits discrimination on

the basis of sex; (c) Section 504 of the Rehabilitation

Act of 1973, as amended (29 U.S.C. §794), which

prohibits discrimination on the basis of handicaps; (d)

the Age Discrimination Act of 1975, as amended (42

U.S.C. §§6101-6107), which prohibits discrimination

on the basis of age; (e) the Drug Abuse Office and

Treatment Act of 1972 (P.L. 92-255), as amended,

relating to nondiscrimination on the basis of drug

abuse; (f) the Comprehensive Alcohol Abuse and

Alcoholism Prevention, Treatment and Rehabilitation

Act of 1970 (P.L. 91-616), as amended, relating to

nondiscrimination on the basis of alcohol abuse or

alcoholism; (g) §§523 and 527 of the Public Health

Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee-

3), as amended, relating to confidentiality of alcohol

and drug abuse patient records; (h) Title VIII of the

Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as

amended, relating to nondiscrimination in the sale,

rental or financing of housing; (i) any other

nondiscrimination provisions in the specific statute(s)

under which application for Federal assistance is being

made; and, (j) the requirements of any other

nondiscrimination statute(s) which may apply to the

application.

7.Will comply, or has already complied, with the

requirements of Titles II and III of the Uniform

Relocation Assistance and Real Property Acquisition

Policies Act of 1970 (P.L. 91-646) which provide for

fair and equitable treatment of persons displaced or

whose property is acquired as a result of Federal or

federally-assisted programs. These requirements apply

to all interests in real property acquired for project

purposes regardless of Federal participation in

purchases.

8.Will comply, as applicable, with provisions of the

Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328)

which limit the political activities of employees whose

principal employment activities are funded in whole or

in part with Federal funds.

9.Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§327-333), regarding labor standards for federally-assisted construction subagreements.

10. Will comply, if applicable, with flood insurance purchase

requirements of Section 102(a) of the Flood Disaster

Protection Act of 1973 (P.L. 93-234) which requires

recipients in a special flood hazard area to participate in the

program and to purchase flood insurance if the total cost of

insurable construction and acquisition is $10,000 or more.

11.Will comply with environmental standards which may be

prescribed pursuant to the following: (a) institution of

environmental quality control measures under the National

Environmental Policy Act of 1969 (P.L. 91-190) and

Executive Order (EO) 11514; (b) notification of violating

facilities pursuant to EO 11738; (c) protection of wetlands

pursuant to EO 11990; (d) evaluation of flood hazards in

floodplains in accordance with EO 11988; (e) assurance of

project consistency with the approved State management

program developed under the Coastal Zone Management

Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of

Federal actions to State (Clean Air) Implementation Plans

under Section 176(c) of the Clean Air Act of 1955, as

amended (42 U.S.C. §§7401 et seq.); (g) protection of

underground sources of drinking water under the Safe

Drinking Water Act of 1974, as amended (P.L. 93-523);

and, (h) protection of endangered species under the

Endangered Species Act of 1973, as amended (P.L. 93-

205).

12.Will comply with the Wild and Scenic Rivers Act of

1968 (16 U.S.C. §§1271 et seq.) related to protecting

components or potential components of the national

wild and scenic rivers system.

13.Will assist the awarding agency in assuring compliance

with Section 106 of the National Historic Preservation

Act of 1966, as amended (16 U.S.C. §470), EO 11593

(identification and protection of historic properties), and

the Archaeological and Historic Preservation Act of

1974 (16 U.S.C. §§469a-1 et seq.).

14.Will comply with P.L. 93-348 regarding the protection of

human subjects involved in research, development, and

related activities supported by this award of assistance.

15.Will comply with the Laboratory Animal Welfare Act of

1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et

seq.) pertaining to the care, handling, and treatment of

warm blooded animals held for research, teaching, or

other activities supported by this award of assistance.

16.Will comply with the Lead-Based Paint Poisoning

Prevention Act (42 U.S.C. §§4801 et seq.) which

prohibits the use of lead-based paint in construction or

rehabilitation of residence structures.

17.Will cause to be performed the required financial and

compliance audits in accordance with the Single Audit

Act Amendments of 1996 and OMB Circular No. A-133,

"Audits of States, Local Governments, and Non-Profit

Organizations."

18.Will comply with all applicable requirements of all other

Federal laws, executive orders, regulations, and policies

governing this program.

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL

TITLE

APPLICANT ORGANIZATION

DATE SUBMITTED

Standard Form 424B (Rev. 7-97) Back

CERTIFICATION REGARDING LOBBYING

Applicants must review the requirements for certification regarding lobbying included in the regulations cited below before completing this form. Applicants must sign this form to comply with the certification requirements under 34 CFR Part 82, "New Restrictions on Lobbying." This certification is a material representation of fact upon which the Department of Education relies when it makes a grant or enters into a cooperative agreement.

As required by Section 1352, Title 31 of the U.S. Code, and implemented at 34 CFR Part 82, for persons entering into a Federal contract, grant or cooperative agreement over $100,000, as defined at 34 CFR Part 82, Sections 82.105 and 82.110, the applicant certifies that:

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 making of any Federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal grant or cooperative agreement;

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 grant or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions;

The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subgrants and contracts under grants and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certification.

NAME OF APPLICANT PR/AWARD NUMBER AND / OR PROJECT NAME

PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE

SIGNATURE DATE

ED 80-0013 06/04

OMB Control No. 1894-0005 (Exp. 03/31/2017)

NOTICE TO ALL APPLICANTS

The purpose of this enclosure is to inform you about a new provision in the Department of Education's General Education Provisions Act (GEPA) that applies to applicants for new grant awards under Department programs. This provision is Section 427 of GEPA, enacted as part of the Improving America's Schools Act of 1994 (Public Law (P.L.) 103-382).

To Whom Does This Provision Apply?

Section 427 of GEPA affects applicants for new grant awards under this program. ALL APPLICANTS FOR NEW AWARDS MUST INCLUDE INFORMATION IN THEIR APPLICATIONS TO ADDRESS THIS NEW PROVISION IN ORDER TO RECEIVE FUNDING UNDER THIS PROGRAM.

(If this program is a State-formula grant program, a State needs to provide this description only for projects or activities that it carries out with funds reserved for State-level uses. In addition, local school districts or other eligible applicants that apply to the State for funding need to provide this description in their applications to the State for funding. The State would be responsible for ensuring that the school district or other local entity has submitted a sufficient section 427 statement as described below.)

What Does This Provision Require?

Section 427 requires each applicant for funds (other than an individual person) to include in its application a description of the steps the applicant proposes to take to ensure equitable access to, and participation in, its Federally-assisted program for students, teachers, and other program beneficiaries with special needs. This provision allows applicants discretion in developing the required description. The statute highlights six types of barriers that can impede equitable access or participation: gender, race, national origin, color, disability, or age. Based on local circumstances, you should determine whether these or other barriers may prevent your students, teachers, etc. from such access or participation in, the Federally-funded project or activity. The description in your application of steps to be taken to overcome these barriers need not be lengthy; you may provide a clear and succinct description of how you plan to address those barriers that are applicable to your circumstances. In addition, the information may be provided in a single narrative, or, if appropriate, may be discussed in connection with related topics in the application.

Section 427 is not intended to duplicate the requirements of civil rights statutes, but rather to ensure that, in designing their projects, applicants for Federal funds address equity concerns that may affect the ability of certain potential beneficiaries to fully participate in the project and to achieve to high standards. Consistent with program requirements and its approved application, an applicant may use the Federal funds awarded to it to eliminate barriers it identifies.

What are Examples of How an Applicant Might Satisfy the Requirement of This Provision?

The following examples may help illustrate how an applicant may comply with Section 427.

(1) An applicant that proposes to carry out an adult literacy project serving, among others, adults with limited English proficiency, might describe in its application how it intends to distribute a brochure about the proposed project to such potential participants in their native language.

(2) An applicant that proposes to develop instructional materials for classroom use might describe how it will make the materials available on audio tape or in braille for students who are blind.

(3) An applicant that proposes to carry out a model science program for secondary students and is concerned that girls may be less likely than boys to enroll in the course, might indicate how it intends to conduct "outreach" efforts to girls, to encourage their enrollment.

We recognize that many applicants may already be implementing effective steps to ensure equity of access and participation in their grant programs, and we appreciate your cooperation in responding to the requirements of this provision.

Estimated Burden Statement for GEPA Requirements

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. Public reporting burden for this collection of information is estimated to average 1.5 hours 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. The obligation to respond to this collection is required to obtain or retain benefit (Public Law 103-382). Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20210-4537 or email ICDocketMgr@ed.gov and reference the OMB Control Number 1894-0005.

Approved by OMB

0348-0046

Type of Federal Action:

a. contract

____ b. grant

c. cooperative agreement

d. loan

e. loan guarantee

f. loan insurance

Status of Federal Action:

a. bid/offer/application

_____ b. initial award

c. post-award

Report Type:

a. initial filing

_____ b. material change

For material change only:

Year _______ quarter _______

Date of last report___________

Name and Address of Reporting Entity:

____ Prime _____ Subawardee

Tier______, if Known:

Congressional District, if known:

If Reporting Entity in No. 4 is Subawardee,

Enter Name and Address of Prime:

Congressional District, if known:

Federal Department/Agency:

Federal Program Name/Description:

CFDA Number, if applicable: ____________

Federal Action Number, if known:

Award Amount, if known:

10. a. Name and Address of Lobbying Registrant

(if individual, last name, first name, MI):

b. Individuals Performing Services (including address if different from No. 10a)

(last name, first name, MI):

11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Signature: __________________________________

Print Name: _____

Title: _____

Telephone No.: ____________ Date: _______

Federal Use Only

Authorized for Local Reproduction

Standard Form - LLL (Rev. 7-97)

Disclosure of Lobbying Activities

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352

(See reverse for public burden

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity 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 a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. Identify the status of the covered Federal action.

3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action.

4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

5. If the organization filing the report in item 4 checks “Subawardee,” then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known.

6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard.

7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments.

8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g., “RFP-DE-90-001.”

9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.

10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action.

(b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI).

11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.

According to the Paperwork Reduction Act, as amended, no persons are 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 OMB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10 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 (0348-0046), Washington, DC 20503

What is GPRA?

The Government Performance and Results Act of 1993 (GPRA) is a straightforward statute that requires all federal agencies to manage their activities with attention to the consequences of those activities. Each agency is to clearly state what it intends to accomplish, identify the resources required, and periodically report their progress to the Congress. In so doing, it is expected that the GPRA will contribute to improvements in accountability for the expenditures of public funds, improve Congressional decision-making through more objective information on the effectiveness of federal programs, and promote a new government focus on results, service delivery, and customer satisfaction.

How has the Department of Education Responded to the GPRA Requirements?

As required by GPRA, the Department of Education has prepared a strategic plan for 2014-2018. This plan reflects the Department’s priorities and integrates them with its mission and program authorities and describes how the Department will work to improve education for all children and adults in the U.S. The Department’s goals, as listed in the plan, are:

Goal 1: Postsecondary Education, Career and Technical Education, and Adult Education.

Increase college access, affordability, quality, and completion by improving postsecondary education and lifelong learning opportunities for youths and adults.

Goal 2: Elementary and Secondary Education.

Improve the elementary and secondary education system’s ability to consistently deliver excellent instruction aligned with rigorous academic standards while providing effective support services to close achievement and opportunity gaps, and ensure all students graduate high school college- and career-ready.

Goal 3: Early Learning.

Improve the health, social-emotional, and cognitive outcomes for all children from birth through 3rd grade, so that all children, particularly those with high needs, are on track for graduating from high school college- and career-ready.

Goal 4: Equity.

Increase educational opportunities for and reduce discrimination against underserved students so that all students are well-positioned to succeed.

Goal 5: Continuous Improvement of the U.S. Education System.

Enhance the education system’s ability to continuously improve through better and more widespread use of data, research and evaluation, evidence, transparency, innovation, and technology.

Goal 6: U.S Department of Education Capacity.

Improve the organizational capacities of the Department to implement this strategic plan.

GOVERNMENT PERFORMANCE AND RESULTS ACT (GPRA)

What are the performance indicators for the Predominantly Black Institutions Program?

The performance indicators for the Predominantly Black Institutions Program are part of the Department’s plan for meeting Goal 1.

Program Goal: The purpose of the Predominantly Black Institutions Program is to strengthen eligible institutions to plan, develop, undertake and implement programs to enhance the institution’s capacity to serve more low- and middle-income Black American students; to expand higher education opportunities for eligible students by encouraging college preparation and student persistence in secondary school and postsecondary education; and to strengthen the financial ability of the institution to serve the academic needs of these students.

The performance indicators for the Predominantly Black Institutions Program are:

Enrollment Rate:

The percentage change of the number of full-time degree-seeking undergraduate students enrolled at PBIs. Note that this is a long-term measure, which will be used to periodically gauge performance.

Persistence Rate--four-year institutions:

The percentage of first-time, full-time degree-seeking undergraduate students at four-year PBIs who were in their first year of postsecondary enrollment in the previous year and are enrolled in the current year at the same four-year PBI.

Persistence Rate--two-year institutions:

The percentage of first-time, full-time degree-seeking undergraduate students at two-year PBIs who were in their first year of postsecondary enrollment in the previous year and are enrolled in the current year at the same two-year PBI.

Completion Rate--four-year institutions:

The percentage of first-time, full-time degree-seeking undergraduate students enrolled at four-year PBIs who graduate within six years of enrollment.

Completion Rate--two-year institutions:

The percentage of first-time, full-time degree-seeking undergraduate students enrolled at two-year PBIs who graduate within three years of enrollment.

Efficiency Measure:

Cost per successful program outcome: Federal cost per undergraduate degree at PBIs.

Application Transmittal Instructions

All parts of the Application for Grants under the Predominantly Black Institutions Program (CFDA No. 84.031P) must be submitted as email attachments to pbiprogram@ed.gov.

Phase 1

Part I of the application, the Formula Elements pages, must be transmitted by TBD. The Formula Elements pages must be signed. The signed copy can be scanned and sent via email, or faxed to: Predominantly Black Institutions Program, fax number (202) 401-8466.

Phase 2

Parts II and III of the application, the Project Plan and the standard forms and certifications, must be transmitted by TBD. Parts II and III must also be submitted as an email attachment to pbiprogram@ed.gov. The signed copies of the standard forms may be scanned and sent via email, or faxed to: Predominantly Black Institutions Program, fax number (202) 401-8466.

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. Public reporting burden for this collection of information is estimated to average 20 hours 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. The obligation to respond to this collection is required (under 34 CFR §608.3) to obtain or retain benefit (Section 322(2) of the Higher Education Act of 1965, as amended (HEA)). Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to regulations.gov during the public comment period for this collection of information. If you have specific questions about the form, instrument, or survey, please contact Dr. Josephine Hamilton, Director, Historically Black Colleges and Universities Division, Office of Postsecondary Education, 400 Maryland Avenue, SW, Washington, D.C. 20202.

File Type	application/msword
File Title	Archived FY 2010 Grant Application - Predominantly Black Institutions Formula Grant Program (MS Word)
Author	Office of Postsecondary Education
Last Modified By	Mullan, Kate
File Modified	2017-02-24
File Created	2017-02-24