Work Colleges Application and Agreement Form and Instruction

OMB No: 1845-XXXX

Expires: XX/XX/XXXX

The deadline for submitting 2019-2020 Application and Agreement electronically and delivering the signed copy to the U.S. Department of Education is Monday, March 4, 2019.

Electronic Submission: The deadline for electronic submission of the application is 11:59 P.M. (ET) on March 4, 2019. Transmissions must be completed and accepted by 12:00 midnight.

Signature: This form must be signed manually, see instructions. The eSignature option has been discontinued.

Mailing Instructions: If the signed copy of the application is sent through the U.S. Postal Service, it must be postmarked by March 4, 2019 and mailed to:

United States Department of Education
Federal Student Aid
Grants & Campus-Based Division
CTP Program
830 First Street, NE, Rm 63C5
Washington, DC 20202-5453

If the signed copy of the application is hand delivered by a commercial courier, use the address provided above except use 20002 as the zip code and it must be delivered by 4:30 P.M. (ET) on
March 4, 2019.

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 1845-XXXX.  Public reporting burden for this collection of information is estimated to average 2 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 mandatory in accordance with the 1998 Amendments to the Higher Education Act of 1965 (Pub. L. 105-244 Sec. 424) and the Higher Education Opportunity Act of 2008 (Pub. L. 110-315). If you have comments or concerns regarding the status of your individual submission of this form, please contact the Grants & Campus-Based Division Call Center directly at 877/801-7168 or email CBFOB@ed.gov.

Institutional Application and Agreement

for Participation in the Work Colleges Program

for the 2019-2020 Award Year

Institution Name: [prefilled by COD]

Street Address: [prefilled by COD]

City: [prefilled by COD] State: [prefilled by COD] Zip Code: [prefilled by COD]

OPEID: [prefilled by COD]

Authorized Official: [prefilled by COD]

Title: [prefilled by COD]

Telephone No.: [prefilled by COD]

E-Mail Address: [prefilled by COD]

Agreement

The undersigned authorized official hereby assures the Secretary of the U.S. Department of Education (the Secretary) that the institution will comply with all provisions of Section 448 of the Higher Education Act of 1965, as amended (HEA), and the applicable program regulations, and makes the following assurances:

• The institution is a public or private nonprofit, four-year, degree-granting institution with a commitment to community service;

• The institution has operated a comprehensive work-learning-service program for at least two years;

• The institution requires students, including at least one-half of all students who are enrolled on a full-time basis, to participate in a comprehensive work-learning-service program for at least five hours each week, or at least 80 hours during each period of enrollment, except summer school, unless the student is engaged in an institutionally organized or approved study abroad or externship program;

• The institution provides students participating in the comprehensive work-learning-service program with the opportunity to contribute to their education and to the welfare of the community as a whole;

• The institution has a comprehensive work-learning-service program that:

1. Is an integral and stated part of the institution’s educational philosophy and program;

2. Requires participation of all resident students for enrollment and graduation;

3. Includes learning objectives, evaluation, and a record of work performance as part of each student’s college record;

4. Provides programmatic leadership by college personnel at levels comparable to traditional academic programs;

5. Recognizes the educational role of work-learning-service supervisors; and

6. Includes consequences for non-performance or failure in the work-learning-service program similar to the consequences for failure in the regular academic program.

• The institution understands that in addition to any separately allocated funds, the institution may transfer allocated 2018-2019 Federal Work-Study (FWS) Program funds to the Work Colleges Program to provide flexibility in strengthening the self-help-through-work element in financial aid packaging for eligible students;

• The institution will match Federal funds used for the Work Colleges Program on a dollar-for-dollar basis from non-Federal sources; and

• The institution understands that available Federal funds may be used:

1. To support the educational costs of qualified students through self-help payments or credits provided under the work-learning-service program of the institution within the limits of Part F of Title IV of the HEA;

2. To promote the work-learning-service experience as a tool of postsecondary education, financial self-help, and community service-learning opportunities;

3. To carry out activities described in Section 443 or 446 of the HEA;

4. For the administration, development, and assessment of comprehensive work-learning-service programs, including—

1. Community-based work-learning-service alternatives that expand opportunities for community service and career-related work; and

2. Alternatives that develop sound citizenship, encourage student persistence, and make optimum use of assistance under Part C of Title IV of the HEA in education and student development;

5. To coordinate and carry out joint projects and activities to promote work service learning; and

6. To carry out a comprehensive, longitudinal study of student academic progress and academic and career outcomes, relative to student self-sufficiency in financing their higher education, repayment of student loans, continued community service, kind and quality of service performed, and career choice and community service selected after graduation.

Application for Funds

I am requesting a separate allocation of $______________ for an anticipated ________students for the Work Colleges Program for the 2019-2020 Year. (Do not include any amount you anticipate transferring from your 2019-2020 FWS allocation.)

This Agreement may be terminated either by the Institution or by the Secretary under the applicable regulations governing this program. The Secretary will establish the termination date.

___________________________________________

Signature of Authorized Official of the Institution Date____________

____________________________________________

U.S. Department of Education Authorizing Official Date____________

2019-2020 Work Colleges Application Page 5 of 5