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Description of Services Ordered and Certification Form 471 FCC Form

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Description of Services Ordered and Certification Form 471 FCC Form OMB 3060-0806 Approval by OMB FCC Form 471 November 2015 Description of Services Ordered and Certification Form 471 FCC Form 471 Application Information Nickname American Samoa Yr20-Tel Application Number 171025640 Funding Year 2017 Category of Service Category 1 Billed Entity Contact Information AMERICAN SAMOA SEA Brittany Mosqueda P. O. BOX DOE PAGO PAGO AS 96799 661-716-1840 684-633-7924 [email protected] [email protected] Billed Entity Number 150224 FCC Registration Number 0011750395 Applicant Type School District Corrina Rodriguez - [email protected] Holiday/Summer Contact Information Consulting Firms Name Consultant City State Zip Phone Email Registration Code Number Number Infinity Communications & Consultin 16043605 Bakersfield CA 93312 661-716-1840 fred.brakeman@infinityco g mm.com Entity Information School District Entity - Details BEN Name Urban/ State State NCES School District Endowment Rural LEA ID School Code Attributes ID 150224 AMERICAN SAMOA SEA Urban Public School District None Related Entity Information Related Child School Entity - Details BEN Name Urban/ State State NCES Code Alternative School Attributes Endowment Rural LEA ID School ID Discount 199075 AFONO ELEM Urban Survey Public School None 199107 ALATAUA LUA/ Urban Survey Public School None TAPUTAPU ELEM Page 1 BEN Name Urban/ State State NCES Code Alternative School Attributes Endowment Rural LEA ID School ID Discount 199108 TUATOO TAUTALATASI Rural Survey Public School None ELEM 199109 AUA ELEM Urban Survey Public School None 199110 MATATULA ECE Urban Survey Public School None 199112 FAGA'ITUA HIGH Urban Survey Public School None SCHOOL 199113 FALEASAO ELEM Urban Survey Public School None 199116 FITIUTA ELEM Urban Survey Public School None 199117 A.P. LUTALI ELEM Rural Survey Public School None 199118 LE'ATELE ELEM Urban Survey Public School None 199121 LEONE MIDKIFF ELEM Urban Survey Public School None 199122 LUPELELE ELEM Urban Survey Public School None 199123 MANU'A HIGH SCHOOL Urban Survey Public School None 199124 MANULELE ELEM Urban Survey Public School None 199125 MATAFAO ELEM Urban Survey Public School None 199126 MATATULA ELEM Urban Survey Public School None 199127 MAUGA O ALAVA ELEM Urban Survey Public School None 199128 OLOMOANA ELEM Urban Survey Public School None 199129 OLOSEGA ECE Urban Survey Pre-K; Public School None 199130 COLEMAN ELEM (Pago Urban Survey Public School None Pago) 199131 PAVA'IA'I ELEM Urban Survey Public School None 199134 SAMOANA HIGH Urban Survey Public School None SCHOOL 199135 SILIAGA ELEM Urban Survey Public School None 199136 TAFUNA HIGH SCHOOL Urban Survey Public School None 199138 NU'UULI VOCATIONAL Urban Survey Public School None TECHNICAL HIGH SCHOOL 199139 MASEFAU ELEM Urban Survey Public School None 199140 MARY THE MOTHER Urban Survey Public School None 199141 MARIST ST. FRANCIS Urban Survey Public School None 199142 SPICC Urban Survey Public School None 199143 MANUMALO BAPTIST Urban Survey Public School None ACADEMY 199145 ST. THERESA ELEM Urban Survey Public School None 199148 IAKINA ADVENTIST Urban Survey Public School None ACADEMY (SDA) 199149 NAZARETH MONTESORY Urban Survey Public School None 199150 PACIFIC HORIZONS Urban Survey Public School None 199151 KANANAFOU ELEM Urban Survey Public School None 199152 SOUTH PACIFIC Urban Survey Public School None ACADEMY (SPA) 199155 FA'ASAO MARIST HIGH Urban Survey Public School None 199156 TAFUNA ELEM Urban Survey Public School None 199157 SAMOA BAPTIST Urban Survey Public School None ACADEMY (HAPPY VALLEY) 224617 JUVENILE DETENTION Urban Survey Juvenile Justice; None CENTER Public School Page 2 BEN Name Urban/ State State NCES Code Alternative School Attributes Endowment Rural LEA ID School ID Discount 16044866 PETELI ACADEMY Urban Survey Public School None 16058187 COLEMAN ECE (Pago Urban Survey Pre-K; Public School None Pago) 16058189 MASEFAU ECE Urban Survey Pre-K; Public School None 16058191 MAUGA O ALAVA ECE Urban Survey Pre-K; Public School None 16058192 OLOSEGA ELEM Urban Survey Public School None 16058212 A.P. LUTALI ECE Rural Survey Pre-K; Public School None 16058214 AFONO ECE Urban Survey Pre-K; Public School None 16058217 AUA ECE Urban Survey Pre-K; Public School None 16058218 LE'ATELE ECE Urban Survey Pre-K; Public School None 16058220 MATAFAO ECE Urban Survey Pre-K; Public School None 16058465 LAULI'I ECE Urban Survey Pre-K; Public School None 16062601 ALATAUA LUA ECE Urban Survey Pre-K; Public School None 16062602 FAGA'ITUA ECE Urban Survey Pre-K; Public School None 16062603 LAULI'I ELEM Urban Survey Public School None 16062604 LUPELELE ECE Urban Survey Pre-K; Public School None 16062606 OLOMOANA ECE Urban Survey Pre-K; Public School None 16062607 SILIAGA ECE Urban Survey Pre-K; Public School None 16055290 LEONE ECE Urban Survey Pre-K; Public School None 16055291 TAU ECE Rural Survey Pre-K; Public School None 17010302 TAFUNA ECE Urban Survey Public School None 16055289 KANANAFOU HIGH Urban Survey Public School None SCHOOL 199119 LEONE HIGH SCHOOL Urban Survey Public School None 17010594 PAVAIAI ECE Urban Survey Public School None Related Child School Entity - Discount Rate Calculation Details BEN Name Urban/ Number of Students CEP Rural Students Count Based Percentage on Estimate 199075 AFONO ELEM Urban 63 N/A 199107 ALATAUA LUA/TAPUTAPU ELEM Urban 262 N/A 199108 TUATOO TAUTALATASI ELEM Rural 153 N/A 199109 AUA ELEM Urban 420 N/A 199110 MATATULA ECE Urban 22 N/A 199112 FAGA'ITUA HIGH SCHOOL Urban 557 N/A 199113 FALEASAO ELEM Urban 70 N/A 199116 FITIUTA ELEM Urban 36 N/A 199117 A.P. LUTALI ELEM Rural 79 N/A 199118 LE'ATELE ELEM Urban 79 N/A 199121 LEONE MIDKIFF ELEM Urban 859 N/A 199122 LUPELELE ELEM Urban 740 N/A 199123 MANU'A HIGH SCHOOL Urban 53 N/A 199124 MANULELE ELEM Urban 1030 N/A 199125 MATAFAO ELEM Urban 584 N/A 199126 MATATULA ELEM Urban 175 N/A Page 3 BEN Name Urban/ Number of Students CEP Rural Students Count Based Percentage on Estimate 199127 MAUGA O ALAVA ELEM Urban 61 N/A 199128 OLOMOANA ELEM Urban 100 N/A 199129 OLOSEGA ECE Urban 12 N/A 199130 COLEMAN ELEM (Pago Pago) Urban 555 N/A 199131 PAVA'IA'I ELEM Urban 1169 N/A 199134 SAMOANA HIGH SCHOOL Urban 946 N/A 199135 SILIAGA ELEM Urban 182 N/A 199136 TAFUNA HIGH SCHOOL Urban 1208 N/A 199138 NU'UULI VOCATIONAL TECHNICAL HIGH SCHOOL Urban 352 N/A 199139 MASEFAU ELEM Urban 91 N/A 199140 MARY THE MOTHER Urban 40 N/A 199141 MARIST ST. FRANCIS Urban 132 N/A 199142 SPICC Urban 297 N/A 199143 MANUMALO BAPTIST ACADEMY Urban 689 N/A 199145 ST. THERESA ELEM Urban 167 N/A 199148 IAKINA ADVENTIST ACADEMY (SDA) Urban 225 N/A 199149 NAZARETH MONTESORY Urban 70 N/A 199150 PACIFIC HORIZONS Urban 144 N/A 199151 KANANAFOU ELEM Urban 522 N/A 199152 SOUTH PACIFIC ACADEMY (SPA) Urban 227 N/A 199155 FA'ASAO MARIST HIGH Urban 290 N/A 199156 TAFUNA ELEM Urban 961 N/A 199157 SAMOA BAPTIST ACADEMY (HAPPY VALLEY) Urban 209 N/A 224617 JUVENILE DETENTION CENTER Urban 6 N/A 16044866 PETELI ACADEMY Urban 131 N/A 16058187 COLEMAN ECE (Pago Pago) Urban 125 N/A 16058189 MASEFAU ECE Urban 28 N/A 16058191 MAUGA O ALAVA ECE Urban 28 N/A 16058192 OLOSEGA ELEM Urban 43 N/A 16058212 A.P. LUTALI ECE Rural 10 N/A 16058214 AFONO ECE Urban 9 N/A 16058217 AUA ECE Urban 50 N/A 16058218 LE'ATELE ECE Urban 14 N/A 16058220 MATAFAO ECE Urban 58 N/A 16058465 LAULI'I ECE Urban 28 N/A 16062601 ALATAUA LUA ECE Urban 12 N/A 16062602 FAGA'ITUA ECE Urban 12 N/A 16062603 LAULI'I ELEM Urban 190 N/A 16062604 LUPELELE ECE Urban 110 N/A 16062606 OLOMOANA ECE Urban 10 N/A 16062607 SILIAGA ECE Urban 25 N/A 16055290 LEONE ECE Urban 115 N/A 16055291 TAU ECE Rural 15 N/A 17010302 TAFUNA ECE Urban 125 N/A 16055289 KANANAFOU HIGH SCHOOL Urban 136 N/A Page 4 BEN Name Urban/ Number of Students CEP Rural Students Count Based Percentage on Estimate 199119 LEONE HIGH SCHOOL Urban 848 N/A 17010594 PAVAIAI ECE Urban 55 N/A Related School District NIFs School School District Name NIF BEN NIF Name District BEN 150224 AMERICAN SAMOA SEA 199154 FELETI BARSTOW PUBLIC LIBRARY 150224 AMERICAN SAMOA SEA 16063464 TESTING OFFICE 150224 AMERICAN SAMOA SEA 199137 SPECIAL EDUCATION 150224 AMERICAN SAMOA SEA 199153 DEPARTMENT OF EDUCATION 150224 AMERICAN SAMOA SEA 16037790 E-RATE OFFICE 150224 AMERICAN SAMOA SEA 16044865 SCHOOL LUNCH 150224 AMERICAN SAMOA SEA 16062608 WAREHOUSE 150224 AMERICAN SAMOA SEA 16055284 CHANCERY OFFICE 150224 AMERICAN SAMOA SEA 16055285 TEACHER QUALITY OFFICE 150224 AMERICAN SAMOA SEA 16055286 DOE LIBRARY 150224 AMERICAN SAMOA SEA 16055287 OFFICE OF CURRICULUM AND INSTRUCTION 150224 AMERICAN SAMOA SEA 16055288 TRANSPORTATION 150224 AMERICAN SAMOA SEA 16085198 JROTC 150224 AMERICAN SAMOA SEA 16085199 ATHLETICS OFFICE 150224 AMERICAN SAMOA SEA 16085202 ELEMENTARY OFFICE 150224 AMERICAN SAMOA SEA 16085204 DUAL LANGUAGE OFFICE 150224 AMERICAN SAMOA SEA 17010303 EARLY CHILDHOOD EDUCATION 150224 AMERICAN SAMOA SEA 17010592 ATHLETICS OFFICE #2 150224 AMERICAN SAMOA SEA 17010593 TEACHER QUALITY OFFICE #2 Discount Rate School District School District School District School District Category One Category Two Voice Enrollment NSLP Count NSLP Percentage Urban/ Discount Rate Discount Rate Discount Rate Rural Status 16014 12171 77.0% Urban 90% 85% 30% Page 5 Funding Request for FRN #1799054427 Funding Request Nickname: Local Lines Service Type: Voice What is the FRN number from the previous 1699121953 year ? Agreement Information - Contract Contract Number Account Number User-entered Establishing FCC 190310001124783 Service Provider American Samoa Form 470# Telecommunications Authority IXC Division (SPN: 143002923)
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