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Temporary Emergency Impact Aid for Displaced Students

Hurricane Education Recovery Act
Temporary Emergency Impact Aid for Displaced Students
Certification by Nonpublic Schools
Directions 

Printable Version (34 kb PDF)

Page 1 –

Name of Nonpublic School:

Enter the name of the nonpublic school.

Street/P.O. Box:

Enter the street name and/or p.o. box number of the nonpublic school.

City:

Enter the name of the city in which the nonpublic school is located.

County:

Enter the name of the county in which the nonpublic school is located.

State & Zip:

Enter the state name and zip code of the nonpublic school.

 

 

Contact Person:

Enter the name of the contact person for this grant.

Title:

Enter the title of the contact person.

Phone:

Enter the phone number of the contact person.

Fax:

Enter the fax number of the contact person.

E-Mail:

Enter the e-mail address of the contact person.

LEA:

Enter the name of the LEA in which the nonpublic school is located.

Certifications:

Type the name and title of the authorized representative.  The authorized representative signs and dates the certifications.
Page 2 –
  • Enter the name of each displaced student.
  • Enter the enrollment start date for each displaced student.
  • Place a check under each quarter, specified by date, in which the displaced student is enrolled (PLEASE NOTE: Complete information only for Quarter One and Quarter Two on the initial application.  Information for Quarter Three and Quarter Four will be collected at a later date).
  • If applicable, enter the enrollment end date for each displaced student.