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Enhancing Education Through Technology Form No. 84.138

This form is available for download here:[download PDF] | [download Word]

The State of ____________________ pledges its support for implementing a statewide, long-range, strategic educational technology plan under Part D of Title II of the Elementary and Secondary Education Act and submits this application for first-year funding under the Ed-Tech Program.

(No. 84.318 in the Catalog of Federal Domestic Assistance)

1. Legal Name of Applicant Agency (State Educational Agency):	2. D.U.N.S. number: Taxpayer Identification Number (TIN):
Applicant Address (include Zip):	3. Contact Person Name: Position: Telephone: Fax: E-mail:
4. Status With Respect to Executive Order 12372: Application was made available for review Program was not selected for review	5. Is the applicant delinquent on any Federal debt? No Yes, explanation attached
6. To the best of my knowledge and belief, all data in this application are true and correct. The document has been duly authorized by the governing body of the applicant and the applicant will comply with the attached assurances if the assistance is awarded.
a. Typed Name and Title of Authorized Representative:	b. Telephone Number: Fax: E-mail:

Form Instructions

Legal Name and Address. Enter the legal name of applicant and the name of the primary organizational unit which will undertake the assistance activity.
D-U-N-S Number. Enter the applicant's D-U-N-S Number. If your organization does not have a D-U-N-S Number, you can obtain the number by calling 1-800-333-0505 or by completing a D-U-N-S Number Request Form. The form can be obtained via the Internet at the following URL: http://www.dnb.com/

Taxpayer Identification Number. Enter the taxpayer's identification number as assigned by the Internal Revenue Service.
Program Contact. Name, address, telephone and fax numbers, and email address of the person to be contacted on matters involving this application.
Executive Order 12372. The purpose of Executive Order 12372 is to foster an intergovernmental partnership and strengthen federalism by relying on state and local processes for the coordination and review of proposed Federal financial assistance and direct Federal development.

Applicants should contact their appropriate State Single Point of Contact (SPOC) to find out about, and to comply with, the state's process under Executive Order 12372. If you want to know the name and address of your State SPOC, you may view the latest SPOC list on the OMB Web site at http://www.whitehouse.gov/omb/grants/ under the heading "Intergovernmental Review (SPOC) list".

In states that have not established a process or chosen a program for review, area wide, regional, and local entities may submit Intergovernmental Review comments directly to the Department.
Federal Debt Delinquency. Check "Yes" if the SEA is delinquent on any Federal debt. (This question refers to the applicant's organization and not to the person who signs as the authorized representative. Categories of debt include delinquent audit disallowances, loans and taxes.) Otherwise, check "No."

Certification. To be signed by the authorized representative of the applicant. A copy of the governing body's authorization for you to sign this application as official representative must be on file in the applicant's office.

Narrative Instructions

Part D of Title II of the Elementary and Secondary Education Act of 1965, as amended by the No Child Left Behind Act of 2001, requires you to submit the information identified below to receive funding under the Ed-Tech State Grant Program.

In organizing this portion of your application, please use the same headings and numbering that we have provided so that reviewers can quickly and accurately locate your response to each item.

For each item, please provide a brief narrative response or identify and indicate the specific portion(s) of your State Educational Technology Plan in which the required information may be found. You may submit a hard copy of your State Educational Technology Plan or provide the web address (URL/URI) for the plan. In either case, all references to the plan should identify the specific sections of the plan that address a given component and provide a heading or other information to assist reviewers.

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