U.S. Department of Education Washington, D.C. 20202-5335 • APPLICATION FOR GRANTS UNDER THE Indian Demonstration Grants for Indian Children CFDA # 84.299A PR/Award# S299Al60J 14 Gramts.gov T racking#: GRANT12173394 OMB No. 18 10-0722, Expiration Date: 06/30n018 Closing Date: MaUJ., 20 16 PR/Award # S299Al60 11 4 **Table of Contents** Form Page 1. Application for Federal Assistance SF-424 e3 2. Standard Budget Sheet (ED 524) e6 3. Assurances Non-Construction Programs (SF 4248) ea 4. ED GEPA427 Form e10 Attachment· 1 (1235-SJSD GEPA Statement) e11 5. Grants.gov Lobbying Form e12 6. Dept ofEducation Supplemental Information for SF-424 e13 7. ED Abstract Narrative Form e14 Attachment· 1 (1234-SJSD Project Abstract) e15 8. Form SFLLL·V1.1.pdf e17 9. Form Other-V1.1.pdf e18 10. Form Project-V1.1.pdf e19 11. Form Budget·V1.1.pdf e20 Attachment· 1236-SJSD Budget Narrative.pd! e21 Attachment· 1250-SJSD Application Narrative.pd! e30 Attachment· 1237-A TT1·Area Map.pdf e61 Attachment · 1248-A TT12-JOM·IEC Agenda.pd! e62 Attachment - 1249-A TT13-lndirect Cost Agreement.pd! e63 Attachment - 1239-A TT3·Navajo and Ute MOUs.pdf e64 Attachment- 1238-A TT2-Needs Assessment-Additional Data.pdf e77 Attachment· 1241·A TT5· Tribal Involvement.pd! e80 Attachment· 1240-A TT4-Evidence of Capacity.pd! e95 Attachment - 1243-A TT7-Description of Continuing Activities.pd! e96 Attachment· 1242-A TT6-Research.pdf e97 Attachment· 1245-A TT9·SJSD Native Hiring Preference Policy.pd! e1 06 Attachment· 1244-A TT8-Resumes-Job Descr.pdf e108 Attachment· 1247-ATT11-RA W lnfo.pdf e122 Attachment· 1246-A TT10-Support Letters.pd! e124 This application was generated using the PDF functionality. The PDF functionality automatically numbers the pages in this application. Some pages/sections of this application may contain 2 sets of page numbers. one set created by the applicant and the other set created by e·Application's PDF functionality. Page numbers created by the a-Application PDF functionality will be preceded by the letter e (for example, e l , e2, e3, etc.). Page e2 OMB Number: 4040-0004 Expiration Date: 8/31/2016 Application for Federal Assistance SF-424 • 1. Type of Submission: * 2. Type of Application: ·If Revision, select appropriate letter(s): 0 Preapplication ~New I I ~App li cation O Continuation • Other (Specify): 0 Changed/Corrected Application 0 Revision I I • 3. Date Received: 4. Applicant Identifier: 105/26/2016 I I I 5a. Federal Entity Identifier: 5b. Federal Award Identifier: I I I I State Use Only: 6. Date Received by State: I I 17. State Application Identifier: I I 8. APPLICANT INFORMATION: • a. Legal Name: lsan Juan School District I • b. Employer/Taxpayer Identification Number (EIN/TIN): • c. Organizational DUNS: 187- 6000514 I 110067 308 60000 I d. Address: • Street1 : 1200 N Main St . I Street2: I I •City: Islanding I County/Parish: I I · State: I UT: Utah I Province: I I •Country: USA : UNITED STATES I I * Zip I Postal Code: 184511 - 3600 I e. Organizational Unit: Department Name: Division Name: I I I I f. Name and contact information of person to be contacted on matters involving this application: Prefix: IMrs . I • First Name: !Lynnette I Middle Name: I I •Last Name: !Johnson I Suffix: I I Title: !student Services Direc tor I Organizational Affiliation: I I •Telephone Number: 1435-678-1227 I Fax Number: 1435-678-3735 I • Email: ll johnsonl @sjsd.org I PR/Award# S299A 16011 4 Page e3 Tracking Number: GRANTl2173394 Funding Opportunity Number:ED-GRANTS-022916-002 Received Date:May 26, 2016 02:33:47 PM EDT Application for Federal Assistance SF-424 * 9. Type of Applicant 1: Select Applicant Type: Ix: Other (specify) I Type of Applicant 2: Select Applicant Type: I Type of Applicant 3: Select Applicant Type: I * Other (specify): !Public School District I * 10. Name of Federal Agency: lu.s . Department o f Education I 11 . Catalog of Federal Domestic Assistance Number: 184 . 299 I CFDA Title: Indian Education -­ Special Programs f or Indian Children * 12. Funding Opportunity Number: IED - GRANTS-022916- 002 I *Title: Office o f Elementary and Secondary Education (OESE) : Office o f Indian Education (OIE) : Indian Education Discretionary Grants Programs : Demonstration Grants f or Indian Children Program CFDA Number 84 . 299A 13. Competition Identification Number: 184- 299A2016- l I Title: 14. Areas Affected by Project (Cities, Counties, States, etc.): Add Attachment Delete Attachment View Attachment I I 1 1 1 1 I * 15. Descriptive Title of Applicant's Project: San J uan School Distric t Native Youth Community Pr oject Attach supporting documents as specified in agency instructions. I Add Attachments II Delete Attachments J I View Attachments I PR/Award# S299A1601 14 Page e4 Tracking Number:GRANTl2173394 Funding Opportunity Number:ED-GRANTS-022916-002 Received Date:May 26, 2016 02:33:47 PM EDT Application for Federal Assistance SF-424 16. Congressional Districts Of: • a. Applicant iuT- 003 I • b. Program/Project iuT- 003 I Attach an additional list of Program/Project Congressional Districts if needed. Add Attachment Delete Attachment View Altachrnent I I I 11 1 1 I 17. Proposed Project: • a. Start Date: 109/ 01/2 0161 • b. End Date: !osn112020 I 18. Estimated Funding ($): •a. Federal I 998 , 775 .ooi • b. Applicant I o.ool * c. State o.ooi • d. Local o. ooi • e. Other o.ooi • f. Program Income o. ool 'g.TOTAL 998 , 775 .ooi * 19. Is Application Subject to Review By State Under Executive Order 12372 Process? D a. This application was made available to the State under the Executive Order 12372 Process for review on I I· [8J b. Program is subject to E.O. 12372 but has not been selected by the State for review. D c. Program is not covered by E.O. 12372. • 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.) o ves [8J No If "Yes", provide explanation and attach Add Attachment Delete Attachment View Attachment I I I 11 1 1 I 21 . *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances•* and agree to comply with any resulting terms if I acc,ept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001) [8J *' I AGREE •• The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions. Authorized Representative: Prefix: lor . I * First Name: loougl as I Middle Name: IE I •Last Name: !wright I Suffix: I I * Title: !superintendent I •Telephone Number: 1435- 678-1202 I Fax Number: I I • Email: lctwri ght@sjsd. org I • Signature of Authorized Representative: !Sheri Montella I • Date Signed: 105/2612016 I PR/Award# S299A 160114 Page e5 Tracking Number: GRANTl2173394 Funding Opportunity Number:ED-GRANTS-022916-002 Received Date:May 26, 2016 02:33:47 PM EDT U.S. DEPARTMENT OF EDUCATION OMB Number: 1894-0008 BUDGET INFORMATION Expiration Date: 06/30/2017 NON-CONSTRUCTION PROGRAMS Name of Institution/Organization Applicants requesting funding for only one year should complete the column under "Project Year 1." Applicants requesting funding for multi-year grants should complete all Juan School District lsan I applicable columns. Please read all instructions before completing form. SECTION A - BUDGET SUMMARY U.S. DEPARTMENT OF EDUCATION FUNDS Project Year 4 Budget Project Year 1 Project Year 2 Project Year 3 Project Year 5 Total (c) Categories (a) (b) (d) (e) (f) 1. Personnel 410, 207 . ool I 424 , 233 . ool 438 , 821. oo l 453, 991 .oo l 1, 727 , 2s2. oo l 2. Fringe Benefits 226, 417 . 001 237 , 310 . ooj 248 , 747 .oo j 260, 757 . oo l 973, 231 . oo l 3. Travel 42 , 28 7. ool 39, 888 . ool 39, 888 . 001 39 , 888 . oo l 161 , 951. oo l 4. Equipment o. ool o. ooj o. oo l o. oo l o. oo l 5. Supplies 58 , 463 . 001 49, 650 . 001 49, 650 .001 I 49, 650 .001 207 , 413 .001 6. Contractual 226, 160 . 001 176, 938 . ool 183 , 683 .oo l 180, 497 .oo l 767 , 21a . oo l 7. Construction o. ool o. ooj o. oo j o. oo l o. oo l 8. Other i. ooo . ool i. ooo . ooj i. ooo . oo l 1, ooo . oo l 4,000.oo l 9. Total Direct Costs 964, 534 . ool 929, 019. 001 961 , 789 . oo l 985, 783 . oo l 3, 841 , 125 .001 (lines 1-81 10. Indirect Costs• 34 , 241. ool 32 , 980 . ooj 34 , 143 .oo j 34 , 995 .oo l 136, 359 . oo l 11. Training Stipends o. ool I o. ool o. oo j o. oo l o. oo l 12. Total Costs 998 , 775 . 001 1 961, 999 . ool 995, 932 .oo l 1, 020, 778 .001 3, 977 , 484 .oo l (lines 9-11) *Indirect Cost Information (To Be Completed by Your Business Office): If you are requesting reimbursement for indirect costs on line 10, please answer the following questions: (1) Do you have an Indirect Cost Rate Ag reement approved by the Federal government? ~ Yes 0No (2) If yes, please provide the following information: Period Covered by the Indirect Cost Rate Agreement: From: 10710112016 I To: 106130/201 7 I (mm/dd/yyyy) Approving Federal agency: ~ ED D Other (please specify): I I The Indirect Cost Rate is I 3.511%.