Elementary And Secondary Education 2018 Application For

U.S. Department of Education Office of Elementary and Secondary Education Office of Safe and Healthy Students Washington, D.C. 20202-6450 ELEMENTARY AND SECONDARY EDUCATION 2018 APPLICATION FOR TEMPORARY EMERGENCY IMPACT AID FOR DISPLACED STUDENTS
STATE	DUNS NUMBER		CFDA NUMBER 84.938C
SEA NAME : STREET/P.O. BOX : CITY : COUNTY : STATE & ZIP :
CONTACT PERSON NAME : TITLE : PHONE : FAX : E-MAIL :
I certify that the statements and all of the data included in this application are, to the best of my knowledge and belief, true, complete, and correct. I certify that I am authorized to make the representations and commitments in this application, for and on behalf of the applicant, and otherwise to act as the applicant’s authorized representative in submitting this application for funding.
NAME AND TITLE OF AUTHORIZED REPRESENTATIVE		SIGNATURE		DATE

Information for Setting Quarterly Dates for Submission of Quarterly Numbers of Displaced Students: The Department has identified four suggested quarterly count dates for identifying numbers of eligible displaced students: October 1, 2017; December 1, 2017; February 1, 2018; and April 1, 2018. States may use these dates or select count dates that fall within a 21-day range for each of the quarters, that is, within 10 calendar days before or after these dates. Each State must select four specific dates for the quarterly counts and use those dates consistently for all applicants within the State. Please insert the State’s selected quarter dates, consistent with this guidance, into the charts that follow.
U.S. Department of Education Office of Safe and Healthy Students Washington, D.C. 20202-6450	2018 APPLICATION FOR EMERGENCY IMPACT AID FOR DISPLACED STUDENTS QUARTERLY NUMBERS OF DISPLACED STUDENTS
SEA NAME :
Report total numbers of displaced students in the State by category for each applicable quarter. Use whole numbers only. Do not include any students in more than one category in a single quarter. For each quarter, provide the total number of displaced students reported to the State for the reporting date for that quarter. (SEAs must submit enrollment data for all four quarters of the 2017-18 school year, which may include estimated data for the fourth quarter. SEAs must provide as an update to this application any updated enrollment data generally and any unreported fourth quarter data for the 2017-18 school year once that data becomes available but no later than June 29, 2018.)
	Quarter 1 on , 2017	Quarter 2 on , 2017	Quarter 3 on , 2018	Quarter 4 on , 2018
PUBLIC SCHOOLS: Total number of displaced students in the State, as reported by eligible local educational agencies: enrolled in public schools in the State who are not receiving special education and related services consistent with IDEA, and who are not English learners
PUBLIC SCHOOLS: Total number of displaced students in the State, as reported by eligible local educational agencies: enrolled in public schools in the State, and who are receiving special education and related services consistent with IDEA
PUBLIC SCHOOLS: Total number of displaced students in the State, as reported by eligible local educational agencies: enrolled in public schools in the State, who are not receiving special education and related services consistent with IDEA, and who are English learners

U.S. Department of Education Office of Safe and Healthy Students Washington, D.C. 20202-6450	2018 APPLICATION FOR EMERGENCY IMPACT AID FOR DISPLACED STUDENTS QUARTERLY NUMBERS OF DISPLACED STUDENTS
SEA NAME :
Report total numbers of displaced students in the State by category for each applicable quarter. Use whole numbers only. Do not include any students in more than one category in a single quarter. For each quarter, provide the total number of displaced students reported to the State for the reporting date for that quarter. (SEAs must submit enrollment data for all four quarters of the 2017-18 school year, which may include estimated data for the fourth quarter. SEAs must provide as an update to this application any updated enrollment data generally and any unreported fourth quarter data for the 2017-18 school year once that data becomes available but no later than June 29, 2018.)
	Quarter 1 on , 2017	Quarter 2 on , 2017	Quarter 3 on , 2018	Quarter 4 on , 2018
NON-PUBLIC SCHOOLS: Total number of displaced students in the State: enrolled in eligible non‑public schools in the State, who are not receiving special education and related services consistent with IDEA, and who are not English learners
NON‑PUBLIC SCHOOLS: Total number of displaced students in the State: enrolled in eligible non‑public schools in the State, and who are receiving special education and related services consistent with IDEA
NON‑PUBLIC SCHOOLS: Total number of displaced students in the State: enrolled in eligible non‑public schools in the State, who are not receiving special education and related services consistent with IDEA, and who are English learners

U.S. Department of Education Office of Safe and Healthy Students Washington, D.C. 20202-6450	2018 APPLICATION FOR EMERGENCY IMPACT AID FOR DISPLACED STUDENTS QUARTERLY NUMBERS OF DISPLACED STUDENTS
SEA NAME :
Report total numbers of displaced students in the State by category for each applicable quarter. Use whole numbers only. Do not include any students in more than one category in a single quarter. For each quarter, provide the total number of displaced students reported to the State for the reporting date for that quarter. (SEAs must submit enrollment data for all four quarters of the 2017-18 school year, which may include estimated data for the fourth quarter. SEAs must provide as an update to this application any updated enrollment data generally and any unreported fourth quarter data for the 2017-18 school year once that data becomes available but no later than June 29, 2018.)
		Quarter 1 on , 2017	Quarter 2 on , 2017	Quarter 3 on , 2018	Quarter 4 on , 2018
BIE SCHOOLS: Total number of displaced students in the State: enrolled in eligible Bureau of Indian Education (BIE) schools in the State, who are not receiving special education and related services consistent with IDEA, and who are not English learners
BIE SCHOOLS: Total number of displaced students in the State: enrolled in eligible Bureau of Indian Education (BIE) schools in the State, and who are receiving special education and related services consistent with IDEA
BIE SCHOOLS: Total number of displaced students in the State: enrolled in eligible Bureau of Indian Education (BIE) schools in the State, who are not receiving special education and related services consistent with IDEA, and who are English learners

U.S. Department of Education Office of Safe and Healthy Students Washington, D.C. 20202-6450	2018 APPLICATION FOR EMERGENCY IMPACT AID FOR DISPLACED STUDENTS STATE EDUCATIONAL AGENCY NARRATIVE PARENTAL NOTIFICATION TO LEA
SEA NAME :
Describe the process for the parent or guardian of a displaced student enrolled in a non‑public school to indicate to the eligible local educational agency serving the area in which the non-public school is located that the student is enrolled in the non‑public school.

U.S. Department of Education Office of Safe and Healthy Students Washington, D.C. 20202-6450	2018 APPLICATION FOR EMERGENCY IMPACT AID FOR DISPLACED STUDENTS STATE EDUCATIONAL AGENCY NARRATIVE PAYMENTS TO ACCOUNTS
SEA NAME :
Describe the procedure to be used by eligible local educational agencies to provide payments to accounts on behalf of non‑public school students.

U.S. Department of Education Office of Safe and Healthy Students Washington, D.C. 20202-6450	2018 APPLICATION FOR EMERGENCY IMPACT AID FOR DISPLACED STUDENTS STATE EDUCATIONAL AGENCY NARRATIVE ATTESTATIONS
SEA NAME :
Describe the process to be used by eligible local educational agencies in the State to obtain: (1) Attestations of attendance of eligible displaced students from eligible non-public schools, and (2) Attestations from eligible non‑public schools that accounts established for non‑public students will be used only for allowable purposes.

U.S. Department of Education Office of Safe and Healthy Students Washington, D.C. 20202-6450	2018 APPLICATION FOR EMERGENCY IMPACT AID FOR DISPLACED STUDENTS STATE EDUCATIONAL AGENCY NARRATIVE ASSISTANCE CRITERIA
SEA NAME :
Describe the criteria, including family income, to be used to determine the eligibility for and the amount of assistance under this section provided on behalf of a displaced student attending an eligible non‑public school.

U.S. Department of Education Office of Safe and Healthy Students Washington, D.C. 20202-6450

2018 APPLICATION FOR EMERGENCY IMPACT AID FOR DISPLACED STUDENTS ADDITIONAL CERTIFICATIONS & ASSURANCES

The Authorized Representative assures that the State will comply with all of the requirements that apply to Emergency Impact Aid for Displaced Students including the following:

1. The State will comply with reporting requirements (see 2 CFR 200.333-200.337), including additional reporting required by the Improper Payments Information Act of 2002 (31 U.S.C. 3321 note).
   
   

2. The State will cooperate with any Inspector General examination of records under the program.
   
   
   

3. Any LEA receiving funding under this program will have on file with the State a set of assurances that meets the requirements of section 442 of the General Education Provisions Act (GEPA) (20 U.S.C. 1232e).
   
   
   

4. To the extent applicable, an LEA will include in its local application a description of how the LEA will comply with the requirements of section 427 of GEPA (20 U.S.C. 1228a).
   
   
   

5. The State and other entities will comply with the provisions of all applicable acts, regulations and assurances; the following provisions of Education Department General Administrative Regulations (EDGAR) 34 CFR parts 76, 77, 81, 82, 84, 97, 98, and 99; The OMB Guidelines to Agencies on Governmentwide Debarment and Suspension (Nonprocurement) in 2 CFR part 180, as adopted and amended as regulations of the Department in 2 CFR part 3485; and The Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards in 2 CFR part 200, as adopted and amended as regulations of the Department in 2 CFR part 3474.

NAME AND TITLE OF AUTHORIZED REPRESENTATIVE

SIGNATURE

DATE

Appendix: Definition of Displaced Student

Displaced student

The term "displaced student'' means a student who enrolled in an elementary school or secondary school (other than the school that the student was enrolled in, or was eligible to be enrolled in, on the date that is one week prior to the date that the major disaster or emergency was declared for the area) because such student resides or resided on the date that is one week prior to the date that the major disaster or emergency was declared for the area, in an area for which a major disaster or emergency declared by the President in accordance with section 401 or 501, respectively, of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5170), related to a covered disaster or emergency.

Section 107(b)(1) of Title IV of Division B of Public Law 109-148, as modified by Division B, Subdivision 1, Title VIII of P.L. 115-123, the “Bipartisan Budget Act of 2018.”

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 1810-New. The time required to complete this information collection is estimated to average 40 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

Form Approved:

PAGE 7 – OMB number 1810-XXX

– Expiration date: XX