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 UEN-2016-UBTA-New-Daggett-State-Mat Application Number 161059087 ch Funding Year 2016 Category of Service Category 1 Billed Entity Contact Information Utah Education and Telehealth Network fka Utah Ed Sabrina Scott ucation Network 801-581-3019 101 WASATCH DRIVE SALT LAKE CITY UT 8411 [email protected] 2 801-581-3019 [email protected] Billed Entity Number 150246 FCC Registration Number 0011938024 Applicant Type Consortium Melinda Talbot 801-581-6539 [email protected] Holiday/Summer Contact Information Entity Information Consortium Entities Related School District Entity - Details BEN Name Urban/ State State NCES School District Endowment Rural LEA ID School Code Attributes ID 142791 ALPINE SCHOOL DISTRICT Urban Public School District None 142793 NORTH SUMMIT SCHOOL Rural Public School District None DISTRICT 142794 DUCHESNE COUNTY SCHOOL Rural Public School District None DIST 142796 DAVIS SCHOOL DISTRICT Urban Utah Utah Public School District $0.00 142797 WASATCH COUNTY SCHOOL Rural Public School District None DISTRICT 142800 SOUTH SUMMIT SCHOOL Rural Public School District None DISTRICT 142804 DAGGETT COUNTY SCHOOL Rural Public School District None DISTRICT 142805 MORGAN SCHOOL DISTRICT Rural 18 Public School District None 142809 RICH COUNTY SCHOOL DISTRICT Rural None 142812 PARK CITY SCHOOL DISTRICT Rural None Page 1 BEN Name Urban/ State State NCES School District Endowment Rural LEA ID School Code Attributes ID 142813 JORDAN SCHOOL DISTRICT Urban Public School District None 142814 TOOELE COUNTY SCHOOL Rural None DISTRICT 142817 UINTAH COUNTY SCHOOL Rural 031 Public School District None DISTRICT 142819 MURRAY CITY SCHOOL DISTRICT Urban Public School District None 142821 SALT LAKE CITY SCHOOL Urban Public School District None DISTRICT 142827 GRANITE SCHOOL DISTRICT Urban Public School District None 142830 BOX ELDER SCHOOL DISTRICT Urban Public School District None 142836 LOGAN CITY SCHOOL DISTRICT Urban Public School District None 142840 CACHE SCHOOL DISTRICT Urban Public School District None 142841 OGDEN SCHOOL DISTRICT Urban Public School District None 142844 WEBER SCHOOL DISTRICT Urban Public School District None 142845 CARBON SCHOOL DISTRICT Rural Public School District None 142848 SAN JUAN COUNTY SCHOOL Rural Public School District None DIST 142850 EMERY COUNTY SCHOOL Rural Public School District None DISTRICT 142851 GRAND COUNTY SCHOOL Rural Public School District None DISTRICT 142855 PROVO CITY SCHOOL DISTRICT Urban Public School District None 142856 MILLARD COUNTY SCHOOL Rural Public School District None DISTRICT 142859 TINTIC SCHOOL DISTRICT Rural Public School District None 142862 SOUTH SANPETE SCHOOL Rural Public School District None DISTRICT 142863 NORTH SANPETE SCHOOL Rural 020 Public School District None DISTRICT 142866 JUAB SCHOOL DISTRICT Rural Public School District None 142870 NEBO SCHOOL DISTRICT Urban Public School District None 142872 SEVIER SCHOOL DISTRICT Rural Public School District None 142877 BEAVER COUNTY SCHOOL Rural None DISTRICT 142878 WAYNE COUNTY SCHOOL Rural Public School District None DISTRICT 142880 IRON COUNTY SCHOOL DISTRICT Urban Public School District None 142882 PIUTE COUNTY SCHOOL Rural Public School District None DISTRICT 142884 KANE COUNTY SCHOOL Rural Public School District None DISTRICT 142885 GARFIELD COUNTY SCHOOL Rural Public School District None DIST 142887 WASHINGTON COUNTY SCHOOL Urban 01140 49 Public School District None DISTRICT 16049286 SALT LAKE COMMUNITY ACTION Urban None PARTNERSHIP HEAD START PROGRAM SCHOOL DISTRICT OFFICE 16049398 DAVIS HEAD START PROGRAM Urban None SCHOOL DISTRICT OFFICE Page 2 BEN Name Urban/ State State NCES School District Endowment Rural LEA ID School Code Attributes ID 16049431 UTE INDIAN TRIBE HEAD START Rural None PROGRAM SCHOOL DISTRICT OFFICE 16049485 CENTRO DE LA FAMILIA DE UTAH Rural None HEAD START PROGRAM SCHOOL DISTRICT 16049500 OGDEN-WEBER COMMUNITY Urban Public School District None ACTION PARTNERSHIP HEAD START PROGRAM SCHOOL DISTRICT OFFICE 16049525 RURAL UTAH CHILD Rural Private School District None DEVELOPMENT HEAD START PROGRAM SCHOOL DISTRICT 16049558 SUU HEAD START PROGRAM Rural Public School District None SCHOOL DISTRICT 16049644 MOUNTAINLAND HEAD START Urban Public School District None PROGRAM SCHOOL DISTRICT OFFICE 16050224 CANYONS SCHOOL DISTRICT Urban Public School District None Related Entity Information Consortium Related Entities Related Child School Entity - Details BEN Name Urban/ State State NCES Code Alternative School Attributes Endowment Rural LEA ID School ID Discount 96153 AMERICAN FORK JR Urban None Public School None HIGH SCHOOL 96154 GREENWOOD Urban None Public School None ELEMENTARY SCHOOL 96155 LEGACY ELEMENTARY Urban None Public School None SCHOOL 96156 SHELLEY ELEMENTARY Urban None Public School None SCHOOL 96157 FORBES ELEMENTARY Urban None Public School None SCHOOL 96158 AMERICAN FORK HIGH Urban None Public School None SCHOOL 96159 BARRATT ELEMENTARY Urban None Public School None SCHOOL 96160 DAN W. PETERSON Urban None Public School None SCHOOL 96161 LONE PEAK HIGH Urban None Public School None SCHOOL 96163 HIGHLAND Urban None Public School None ELEMENTARY SCHOOL 96164 MOUNTAIN RIDGE Urban None Public School None JUNIOR HIGH 96165 ALPINE ELEMENTARY Urban None Public School None SCHOOL 96185 CEDAR VALLEY Rural None Public School None ELEMENTARY SCHOOL 96266 LINDON ELEMENTARY Urban None Public School None SCHOOL Page 3 BEN Name Urban/ State State NCES Code Alternative School Attributes Endowment Rural LEA ID School ID Discount 96267 ATEC SCHOOL Urban None Public School; None Adult Education 96268 OAK CANYON JUNIOR Urban None Public School None HIGH 96269 ROCKY MOUNTAIN Urban None Public School None ELEMENTARY 96270 EAGLE CREST Urban None Public School None ELEMENTARY SCHOL 96271 LEHI JUNIOR HIGH Urban None Public School None SCHOOL 96272 SEGO LILY Urban None Public School None ELEMENTARY SCHOOL 96273 LEHI ELEMENTARY Urban None Public School None SCHOOL 96274 LEHI HIGH SCHOOL Urban None Public School None 96275 MEADOW ELEMENTARY Urban None Public School None SCHOOL 96302 GENEVA ELEMENTARY Urban None Public School None SCHOOL 96303 SUNCREST Urban None Public School None ELEMENTARY SCHOOL 96304 NORTHRIDGE Urban None Public School None ELEMENTARY SCHOOL 96305 WINDSOR ELEMENTARY Urban None Public School None SCHOOL 96306 BONNEVILLE Urban None Public School None ELEMENTARY SCHOOL 96307 OREM JUNIOR HIGH Urban None Public School None SCHOOL 96310 MOUNTAIN VIEW HIGH Urban None Public School None SCHOOL 96311 TIMPANOGOS HIGH Urban None Public School None SCHOOL 96312 ASPEN ELEMENTARY Urban None Public School None SCHOOL 96314 OREM ELEMENTARY Urban None Public School None SCHOOL 96315 VINEYARD ELEMENTARY Urban None Public School None SCHOOL 96317 LAKERIDGE JUNIOR Urban None Public School None HIGH SCHOOL 96318 WESTMORE Urban None Public School; Pre-K None ELEMENTARY SCHOOL 96319 CHERRY HILL Urban None Public School None ELEMENTARY SCHOOL 96324 GROVECREST Urban None Public School None ELEMENTARY SCHOOL 96325 PLEASANT GROVE JR Urban None Public School None HIGH SCHOOL 96326 CENTRAL ELEMENTARY Urban None Public School; Pre-K None SCHOOL 96327 PLEASANT GROVE HIGH Urban None Public School None SCHOOL 96328 VALLEY VIEW Urban None Public School None ELEMENTARY SCHOOL 96329 MANILA ELEMENTARY Urban None Public School None SCHOOL Page 4 BEN Name Urban/ State State NCES Code Alternative School Attributes Endowment Rural LEA ID School ID Discount 96454 ORCHARD ELEMENTARY Urban None Public School None SCHOOL 96455 CANYON VIEW JUNIOR Urban None Public School None HIGH SCHOOL 96456 SHARON ELEMENTARY Urban None Public School None SCHOOL 96457 CASCADE ELEMENTARY Urban None Public School None SCHOOL 96458 OREM HIGH SCHOOL Urban None Public School None 96459 SCERA PARK Urban None Public School None ELEMENTARY SCHOOL 96460 HILLCREST Urban None Public School None ELEMENTARY SCHOOL 205500 CEDAR RIDGE Urban None Public School None ELEMENTARY 205503 SUMMIT HIGH SCHOOL Urban Juvenile Justice None 211854 TIMBERLINE MIDDLE Urban None Public School None SCHOOL 211855 SNOW SPRINGS Rural None Public School None ELEMENTARY SCHOOL 211856 MT MAHOGANY Urban None Public School None ELEMENTARY SCHOOL 227178 FOOTHILL ELEMENTARY Urban None Public School None SCHOOL 227179 WESTFIELD Urban None Public School None ELEMENTARY 230352 PONY EXPRESS Urban None Public School None ELEMENTARY SCHOOL 232546 FREEDOM ELEMENTARY Urban None Public School None 232845 DEERFIELD Urban None Public School None ELEMENTARY SCHOOL 16020083 WILLOWCREEK MIDDLE Urban None Public School None SCHOOL 16020143 SARATOGA SHORES Urban None Public School None ELEMENTARY SCHOOL 16026938 EAGLE VALLEY Rural None Public School None ELEMENTARY 16034083 HARVEST ELEMENTARY Urban None Public School None 16034084 RIDGELINE Urban None Public School None ELEMENTARY 16034085 FOX HOLLOW Urban None Public School None ELEMENTARY 16044430 WESTLAKE HIGH Urban None Public School None SCHOOL 16044868 HIDDEN HOLLOW Urban None Public School None ELEMENTARY 16055677 NORTH POINT Urban None Public School None ELEMENTARY 16055678 SAGE HILLS Urban None Public School None ELEMENTARY 16055682 TRAVERSE MOUNTAIN Urban None Public School None ELEMENTARY 16055683 VISTA HEIGHTS MIDDLE Urban None Public School None SCHOOL 16055820 MOUNTAIN TRAILS Rural None Public School None ELEMENTARY SCHOOL Page 5 BEN Name Urban/ State State NCES Code