SQA Application Example_FY25

FY 2025 Rural and Low-Income School - Specially Qualified Agency (RLIS-SQA)
Application
Please read all instructions below:

Welcome to the fiscal year (FY) 2025 Rural and Low-income School - Specially Qualified Agency (RLIS-SQA) grant application. 
On average, the RLIS-SQA application takes 10-30 minutes to complete.
Complete the application by May 16, 2025.

The RLIS-SQA application contains the following sections:
Local Educational Agency (LEA) Information:
LEA Name and Address
Authorized Representative
Secondary Contact
Unique Entity Identifier (UEI)
General Education Provisions Act (GEPA) Statement
Intended Use(s) of Funds
Outcomes and Objectives Statement
Assurances
Certification and Signature
Application Review
Application Submission

After reading all instructions below, you may begin the application by clicking the "Next" button at the bottom of this screen. Once you
have started, you may select "Resume Later" to save your progress. You may then re-access your application using the same link from the invitation
email you received. Similarly, if your session times out, please return to the invitation email and re-click the application link to continue your work. If
you have any questions about this application, or require additional support, please contact the REAP team directly by emailing reap@ed.gov.

After submitting the application, the Authorized Representative who received the invitation email will receive a confirmation email. This email will
come from no-reply.survey@connect.gov and cannot be resent. It is possible that your LEA's security or firewall settings may route this email to a
spam or junk folder or prevent it from being delivered at all and in these cases, REAP recommends working with your LEA's technology support staff
to retrieve the email.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a currently valid OMB control number. The valid
OMB control number for this collection is 1810-0646. Public reporting burden for this collection of information is estimated to average 30-minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is
required to receive awards authorized under the Elementary and Secondary Education Act of 1965, sections 5211-5212 and 5221.

If you have comments concerning the accuracy of the time estimate, suggestions for improving this individual collection, or if you have comments or concerns regarding the status of your individual
submission of this application, please contact the REAP team directly at reap@ed.gov or (202) 401-0039.

There are 16 questions in this survey.

LEA Information
Confirm you are applying for the RLIS-SQA grant for the correct local educational agency (LEA) by reviewing the information below. If the information
is correct, confirm by selecting "Yes." If the information is not correct, select "No" and a space will be provided for you to update the information. As a
reminder, if you are the fiscal agent for more than one RLIS-SQA eligible LEA, a separate application must be submitted for each LEA.

The LEA name, mailing address, and phone number appear as follows:

{TOKEN:ATTRIBUTE_1}
{TOKEN:ATTRIBUTE_2}
{TOKEN:ATTRIBUTE_3}, {TOKEN:ATTRIBUTE_4} {TOKEN:ATTRIBUTE_5}
{TOKEN:ATTRIBUTE_6}

If this information is correct, select "Yes" below. If not, select "No" and update the information in the space
provided.
*

Choose one of the following answers
Please choose only one of the following:
Yes, the LEA contact information is correct.
No, the LEA contact information is not correct.

If your answer to the above question is "No," provide only the corrected LEA information below:

Only answer this question if the following conditions are met:
Answer was 'No, the LEA contact information is not correct.' at question ' [QA010]' (The LEA name, mailing address, and phone number
appear as follows:   {TOKEN:ATTRIBUTE_1} {TOKEN:ATTRIBUTE_2} {TOKEN:ATTRIBUTE_3}, {TOKEN:ATTRIBUTE_4}
{TOKEN:ATTRIBUTE_5} {TOKEN:ATTRIBUTE_6}   If this information is correct, select "Yes" below. If not, select "No" and update the
information in the space provided. )
Please fill in at least one answer
Please write your answer(s) here:
LEA Name:

LEA Address:

LEA City:

LEA State:

LEA Zip:

LEA Phone Number:

The Authorized Representative is the primary person representing the LEA to the Department. Should funds be awarded,
their name will be listed on the Grant Award Notification (GAN). This person is the primary point of contact for the REAP
team and will receive communications from G5, the Department's grants management platform. The Authorized
Representative must be different than the secondary contact. Your LEA's Authorized Representative information appears
below:
{TOKEN:FIRSTNAME} {TOKEN:LASTNAME}
{TOKEN:EMAIL}

If this information is correct, select "Yes" below. If not, select "No" and update the information in the space provided.
*

Choose one of the following answers
Please choose only one of the following:
Yes, the Authorized Representative information is correct.
No, the Authorized Representative information is not correct.
NOTE: The Authorized Representative must be different than the secondary contact.

If your answer to the above question is "No," provide only the corrected Authorized Representative information below:

Only answer this question if the following conditions are met:
Answer was 'No, the Authorized Representative information is not correct.' at question ' [QA030]' ( The Authorized Representative is the
primary person representing the LEA to the Department. Should funds be awarded, their name will be listed on the Grant Award Notification
(GAN). This person is the primary point of contact for the REAP team and will receive communications from G5, the Department's grants
management platform. The Authorized Representative must be different than the secondary contact. Your LEA's Authorized Representative
information appears below: {TOKEN:FIRSTNAME} {TOKEN:LASTNAME} {TOKEN:EMAIL}   If this information is correct, select "Yes" below. If
not, select "No" and update the information in the space provided. )
Please fill in at least one answer
Please write your answer(s) here:
Authorized Representative First Name:

Authorized Representative Last Name:

Authorized Representative Email:

The secondary contact will be listed on the RLIS-SQA GAN and will receive communication from the REAP team and G5,
however they are not the primary point of contact for the LEA. The secondary contact must be different than the Authorized
Representative. Your LEA's secondary contact information appears as follows:

{TOKEN:ATTRIBUTE_14} {TOKEN:ATTRIBUTE_15}
{TOKEN:ATTRIBUTE_16}

If this information is correct, select "Yes" below. If not, select "No" and update the information in the space provided.
*

Choose one of the following answers
Please choose only one of the following:
Yes, the secondary contact information is correct.
No, the secondary contact information is not correct.
NOTE: The secondary contact must be different than the Authorized Representative.

If your answer to the above question is "No," provide only the corrected secondary contact information below:

Only answer this question if the following conditions are met:
Answer was 'No, the secondary contact information is not correct.' at question ' [QA050]' (The secondary contact will be listed on the RLISSQA GAN and will receive communication from the REAP team and G5, however they are not the primary point of contact for the LEA. The
secondary contact must be different than the Authorized Representative. Your LEA's secondary contact information appears as follows:  
{TOKEN:ATTRIBUTE_14} {TOKEN:ATTRIBUTE_15} {TOKEN:ATTRIBUTE_16}   If this information is correct, select "Yes" below. If not, select
"No" and update the information in the space provided. )
Please fill in at least one answer
Please write your answer(s) here:
Secondary Contact First Name:

Secondary Contact Last Name:

Secondary Contact Email:

Unique Entity Identifier:
An LEA must have a UEI with an active registration status in SAM to access its awarded RLIS-SQA funds. An LEA without a
UEI may not receive an RLIS-SQA award until it has obtained and registered a UEI. 
The department has pre-populated the UEI below for any LEA currently registered in the System for Award Management
(SAM) if the REAP team had a prior record of your LEA's UEI. If your UEI is not pre-populated, please enter the UEI
provided to the LEA by SAM.

Review the UEI field below and proceed with one of the following steps:
If the UEI provided in the field below is correct, you may proceed to the next section of the application by selecting
"Next" at the bottom of the page.
If the UEI provided in the field below is not correct, update the field so that it displays the correct UEI for your LEA,
then select "Next" at the bottom of the page.
If the field below is blank, the Department does not have a UEI on file for your LEA. If your LEA has a UEI registered in
SAM.gov, type it into the field below. If your LEA does not have a UEI at this time, please select "Resume Later" to
pause your work on the application. You must visit SAM.gov to request a new UEI free of charge, then resume the
application once you have a UEI available to provide.
*

Please write your answer here:

NOTE: Our records show that your UEI registration's expiration date in SAM.gov is {TOKEN:ATTRIBUTE_9}.

GEPA Statement
Section 427 of the General Education Provisions Act (GEPA) requires Department grantees, such as RLIS-SQA grantees, to describe the steps the
grantee will take to ensure equitable access to, and participation in, the Federally-assisted program by addressing the special needs of students,
teachers, and other program beneficiaries. The statute highlights six types of barriers to equitable participation, including barriers based on gender,
race, national origin, color, disability, or age.

Submit your LEA's FY 2025 GEPA statement by typing or pasting it into the response box below. An example GEPA
statement is displayed in the response box. Review the example statement and revise as needed to ensure it is accurate for
your LEA.
*

Please write your answer here:

NOTE: The maximum character limit is 1000.

Intended Use(s) of Funds
An LEA may use RLIS-SQA funds to pay for activities that are allowable under Title I, Part A; Title II, Part A; Title III; and Title IV, Part A of
the Elementary and Secondary Education Act of 1965, as well as parental involvement activities. RLIS-SQA funds must be used to
supplement, and not supplant, any other Federal, State, or local education funds. All uses of RLIS-SQA funds must be reasonable and
necessary and comply with all requirements in the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards (Uniform Guidance), 2 CFR Part 200.

Using the checkboxes below, please indicate how your LEA intends to use any awarded FY 2025 RLIS-SQA funds. Some intended activities may fit
under multiple categories. In these cases, the REAP team encourages you to select the category that aligns with the primary goal or outcome of the

proposed activity. If you intend to use your funds in multiple ways, you may select multiple boxes.  The categories listed below represent the most
common uses of RLIS-SQA funds; however, the list is not exhaustive, and we recognize these categories do not encompass all possible uses of
funds. 

IMPORTANT NOTE: This information is being collected for data purposes only. Your response to this question is not a binding commitment to
spend RLIS-SQA funds in a certain way and you may use your awarded funds for any allowable purpose. Additionally, the approval of your
application is not an approval or disapproval of your intended use of funds. Because your response is non-binding, you will not receive
confirmation of your selections for this question. If you wish to retain this information, you will need to make note of it now.

If you have questions about your intended use(s) of RLIS-SQA funds, please email REAP@ed.gov and the REAP team will be happy to advise you
on this section of the application.

Please select all of your LEA’s intended use(s) of FY 2025 RLIS-SQA grant funds from the list below.  
*

Select all that apply
Please choose all that apply:
College and Career Readiness or Career and Technical Education (e.g. increased access to advanced dual-enrollment or advanced
coursework like AP or IB)
Data (e.g. Equipment, materials, and training needed to compile and analyze student achievement data.)
Early Childhood or Pre-K Activities
Activities Allowable under Title III (e.g., English language acquisition activities)
Family or Parental Involvement Activities
Improving Academic Achievement
Instructional Materials (NOT Technology)
Library Materials, Staff, and Activities
Professional Development
Reducing Class Size
Safe and Healthy Student Activities (e.g. school climate interventions or increased access to student counseling services)
Staff Compensation
Out of school time programming (e.g. afterschool or summer programming)
Technology – Devices
Technology – Not Devices
You may select any number of choices that best align with your intended use of funds. 

Outcomes and Objectives Statement
Under the ESEA, section 5223(b)(1), an LEA applying for RLIS-SQA funds must provide to the Department its RLIS objectives and
outcomes for allowable activities under the program, including how it will use such funds to help all students meet challenging State
academic standards.

Submit your response in the box below. If the LEA submitted a response on the FY 2024 RLIS-SQA application, the
statement will auto-populate in the space below. Verify that the statement is accurate and update as needed. If your LEA
did not submit an FY 2024 RLIS-SQA application, the space below will be blank. By typing it in the text box below, submit a
current description of your LEA's RLIS objectives and outcomes for allowable activities under the program, including how
your LEA will use such funds to help all students meet challenging State academic standards.
*

Please write your answer here:

NOTE: The maximum character limit is 1000.

Assurances and Signature
As the duly Authorized Representative of the LEA applying for this grant, I certify that the applicant:

1. Has the legal authority to apply for Federal assistance, and the institutional, managerial, and financial capability (including funds sufficient to
pay the non-Federal share of project cost) to ensure proper planning, management, and completion of the project to be funded with RLIS-SQA
funds.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any Authorized
Representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper
accounting system in accordance with generally accepted accounting standards or agency directives.
3.  Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of
personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. §§1501-1508 and §§7324-7328), which limit the political activities of
employees whose principal employment activities are funded in whole or in part with Federal funds.
6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to:
(a) Title VI of the Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color or national origin;
(b) Title IX of the Education Amendments of 1972, as amended, which prohibits discrimination on the basis of sex;
(c) Section 504 of the Rehabilitation Act of 1973, as amended, which prohibits discrimination on the basis of having a disability;
(d) the Age Discrimination Act of 1975, as amended, which prohibits discrimination on the basis of age;
(e) the Drug Abuse Office and Treatment Act of 1972, as amended, relating to nondiscrimination on the basis of drug abuse;
(f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970, as amended, relating to
nondiscrimination on the basis of alcohol abuse or alcoholism;
(g) §§523 and 527 of the Public Health Service Act of 1912, as amended, relating to confidentiality of alcohol and drug abuse patient
records;
(h) Title VIII of the Civil Rights Act of 1968, as amended, relating to nondiscrimination in the sale, rental or financing of housing;
(i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and
(j) the requirements of any other nondiscrimination statute(s) which may apply to the application.
7. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program.

The applicant, through its Authorized Representative, agrees to the required assurances above.
*

Select all that apply
Please choose all that apply:
Agree

By submitting this application, I certify that the statements herein are true, complete, and accurate to the best of my knowledge. I am aware
that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties.
*

Select all that apply
Please choose all that apply:
Agree

Enter today's date: 
*

Please enter a date:

Type the LEA Authorized Representative's signature below:
*

Please write your answer here:

Review Your Application
Review the summary of your application responses below. Use the "Previous" button to go back and make changes. If you do not need to change
any of your LEA's application responses, click "Next" at the bottom of this page to proceed to the final section of the FY 2025 RLIS-SQA grant
application.

Summary of Application Responses:

Application Questions:

LEA Responses:

Is the LEA name, mailing address, and phone number
correct as listed?

   {INSERTANS:534927X3513X40209}

a.

If not, provide the corrected LEA name here:

   {INSERTANS:534927X3513X40210SQ001}

b.

If not, provide the corrected LEA address here:

   {INSERTANS:534927X3513X40210SQ002}

c.

If not, provide the corrected LEA city here:

   {INSERTANS:534927X3513X40210SQ003}

d.

If not, provide the corrected LEA state here:

   {INSERTANS:534927X3513X40210SQ004}

e.

If not, provide the corrected LEA zip code here:

   {INSERTANS:534927X3513X40210SQ005}

If not, provide the corrected LEA phone number here:

   {INSERTANS:534927X3513X40210SQ006}

Is the LEA Authorized Representative name and email
correct?

   {INSERTANS:534927X3513X40211}

a.

If not, provide the corrected Authorized Representative
first name here:

   {INSERTANS:534927X3513X40212SQ001}

b.

If not, provide the corrected Authorized Representative
last name here:

c.

If not, provide the corrected Authorized Representative
email here:

   {INSERTANS:534927X3513X40212SQ003}

Is the LEA secondary contact name and email correct?

   {INSERTANS:534927X3513X40213}

a.

If not, provide the corrected secondary contact first
name here:

   {INSERTANS:534927X3513X40214SQ001}

b.

If not, provide the corrected secondary contact last name
here:

c.

If not, provide the corrected secondary contact
email here:

   {INSERTANS:534927X3513X40214SQ003}

   4.

Provide the LEA's UEI here:

   {INSERTANS:534927X3513X40215}

   5.

LEA's FY 2025 GEPA statement:

   {INSERTANS:534927X3514X40216}

   1.

f.

   2.

   3.

   {INSERTANS:534927X3513X40212SQ002}

   {INSERTANS:534927X3513X40214SQ002}

Intended Use of Funds

Responses to this question are not provided in this
LEA’s intended use of funds described on the FY 20
captures how your LEA plans to use RLIS-SQA fund
this application. The response is non-binding and fo
and reporting purposes only. Your LEA may change
RLIS-SQA funds at any point during the grant perfo
without notifying the REAP team of the change as l
funds are used for allowable activities. If you wish t
responses to this question please use the back butt
question and take note of your response. 

   7.

LEA's FY 2025 outcomes and objectives statement:

   {INSERTANS:534927X3519X40226}

   8.

Date of Application:

   {INSERTANS:534927X3516X40222}

   9.

Authorized Representative's Signature:

   {INSERTANS:534927X3516X40223}

   6.

Submit Your Application
After reading all of the instructions on this page, you may click "Submit" at the bottom to complete the FY 2025 RLIS-SQA grant
application for your LEA.

After your LEA submits the application using the button below, the Authorized Representative who received the invitation email will receive a
confirmation email. This email will come from no-reply.survey@max.gov and cannot be resent. It is possible that your LEA's security or firewall
settings may route this email to a spam or junk folder or prevent it from being delivered at all and in these cases, REAP recommends working with
your LEA's technology support staff to retrieve the email.

*

Choose one of the following answers
Please choose only one of the following:
I have read the information above.

Thank you for submitting the FY 2025 RLIS-SQA grant application!

The Authorized Representative who received the invitation email will receive a confirmation email immediately after the application is submitted. This
email will come from no-reply.survey@connect.gov and cannot be resent. It is possible that your LEA's security or firewall settings may route this
email to a spam or junk folder or prevent it from being delivered at all and in these cases, REAP recommends working with your LEA's technology
support staff to retrieve the email. The confirmation email contains important next steps - review these steps carefully and complete them as soon as
possible. This email will also serve as a copy of your application and will include a summary of your application responses.

You may now exit the browser. 

04/02/2025 – 23:50
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