NORTH CAROLINA TITLE III APPLICATION, 2015-2016
Funds are available 2015-2017 (27 months)
THE NO CHILD LEFT BEHIND ACT OF 2001 (P.L. 107-110)
DUE by Monday, June 1, 2015
Date Approved ___________
LEA Code:
LEA Name:
Contact Person:
Title:
Mailing Address:
Phone Number:
Email Address:
Local Education Agencies (LEAs) eligible to receive Title III funds must agree to spend those funds to educate
Limited English Proficient (LEP) students. [In order to be eligible, LEAs must identify and report a sufficient
number of LEP students to generate a planning allotment of more than $10,000.]
LEA plans are designed to meet federal and state requirements in order to ensure that LEP students acquire
academic English language proficiency and achieve the challenging academic standards for all students in North
Carolina.
This application reflects the requirements of Title III of the No Child Left Behind Act of 2001 and correlates with
the items on the NC Title III Monitoring Instrument.
*Those applying in consortium must share PRC 104 funds; such funds are to be spent by the fiscal agent to carry
out goals written and described in this application by and for the entire group.
Directions:
1.
2.
3.
4.
5.
Save the document to your computer.
Name the file “ Title III2015-16AppLEA Name”. For example, TitleIII2015-16AppWake
Type your responses directly into the document. Complete all items!
Save a copy for your records.
Email a copy of the application to Celia Parker at celia.parker@dpi.nc.gov and your assigned Title
III/ESL Consultant.
6. Email electronic signed copy of the signed assurances and certification regarding debarment,
suspension, ineligibility and voluntary exclusion to Celia Atkison at celia.parker@dpi.nc.gov . (Do NOT
send the entire application via mail or Fax. Keep the original with your records.)
Email Celia Atkison at celia.parker@dpi.nc.gov
Charlotte “Nadja” Trez Nadja.trez@dpi.nc.gov
Lindsey Fults Lindsey.fults@dpi.nc.gov
Ivanna MT Anderson Ivanna.anderson@dpi.nc.gov
Attachement: revised map
NC Title III Application for the 2015-2016 School Year, April 6, 2015
Page 1 of 14
Supplanting and Provision of Language Instruction Educational Programs
Language Instruction Educational Program (LIEP) "Language instruction educational program" means an
instruction course in which LEP students are placed for the purpose of attaining English proficiency, while
meeting challenging State academic content and student academic achievement standards. A language instruction
educational program may make use of both English and a child's native language to enable the child to develop
and attain English proficiency. Programs may include the participation of English proficient students in addition
to LEP students if such a program enables participating students to become proficient in English and a second
language.”
Students can be served by an array of educational professionals through services including but not limited
to: Supplemental Computer Programs, Tutors (ESL/Content), Sheltered Instruction, Co-Teaching, Pullout ESL,
Content-based ESL, Newcomers Program*, Teacher/Student Coaching, District/Student LEP Plan, Small Groups,
Peer Tutoring, Teacher Assistants, ELL related PD for content teachers, Appropriate Scheduling, Targeted
Instructional Modifications/Accommodations (LinguaFolio, SIOP, ExC-ELL, relevant data analysis, use of
supplemental materials, etc.) in collaboration with district ESL staff.
States, districts, and schools are required to provide core language instruction educational programs and services
for limited English proficient (LEP) students. This requirement is established based on Title VI of the Civil Rights Act of
1964, and its implementing regulations, as interpreted by the Supreme Court of the United States (including the Supreme
Court’s ruling in Lau v. Nichols), and based on other significant case law (including Castaneda v. Pickard), the Equal
Educational Opportunities Act of 1974, and other Federal, State, and local laws. Therefore, the use of State or subgrantee
Title III funds to provide core language instruction educational programs, including providing for the salaries of teachers
who provide those core [BASIC] services for LEP students, would violate the supplement not supplant provision in section
3115(g) of the Act, as such services are required to be provided by States and districts regardless of the availability of Title
III funds.
…any efforts by an LEA or school to reduce State and local funds expended to implement language instruction
educational programs serving LEP students based on the receipt of Federal Title III grant funds also violates the nonsupplanting provision of Title III. In the absence of these Federal funds, LEAs would still be required to provide language
instruction educational services and would need to expend funds to serve LEP students. For example, the Department has
encountered numerous Title III subgrantees that, for budgetary reasons, use Title III funds to pay the salaries of their
English as a Second Language (ESL) teachers. Typically, ESL teachers provide the core [BASIC] language instruction
educational program services and their salaries are the responsibility of States and LEAs, not the Federal Government.
Source: U.S. Department of Education, Office of English Language Acquisition, Lyndon Baines Johnson Building, 400 Maryland
Avenue, SW, Room 5C-132, Washington, DC 20202-6510. [See entire document in Appendix IX.]
* See Appendix I for definition of Newcomers Program
NC Title III Application for the 2015-2016 School Year, April 6, 2015
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1. Language Instruction Educational Program (LIEP) Type(s) Provided for ELLs
as part of Basic (Core) and Supplemental Services
These programs must meet the description of LIEPs in Appendix I.
If the description does not reflect your program implementation, you may NOT list that program type.
List LIEP Type
Research Support
[Rows may be added to this table. Click “Table”; add row.]
BASIC (Core) Program for ELLs 2015-2016
Required by the North Carolina State Board of Education and the Office of Civil Rights
State Board Policy ID number GCS-K-000 [Appendix IV] requires that LEAs adopt a program or programs for English Language
Learners which have a reasonable chance of allowing students to progress in school. Therefore the LEA/Charter must employ and
appropriately implement an effective program.
2. BASIC (Core) Program Components
2A. Describe the
 Home Language Survey [HLS]
Process [Appendix II – SAMPLE HLS
Form, Appendix III HLS Process]
[Qualified ESL staff should review the HLS, investigate
any incongruities, and document the home language.
The HLS process should only occur once.]
2B. Describe the
 Process of Identification of LEP
students [Based on the HLS, W-APT scores,
and/or ACCESS for ELLs scores from other
states]
 Parent Notification of Results
2C. Describe evaluation and reporting of
Basic Program
 List data reviewed/analyzed annually
to determine the effectiveness of
program services for ELLs, and
 How AMAO results are shared with
teachers and administrators.
2D. Describe equitable access that
 Ensures the eligibility of ELLs for
AIG, EC, Specialized Programs and/or
Support Services;
 Ensures ELLs are educated in the least
segregative manner, based upon the
program type, and
 Ensures involvement of parents of
ELLs
2E. Describe
 How ELLs’ participation in state
NC Title III Application for the 2015-2016 School Year, April 6, 2015
Page 3 of 14
testing is ensured. [EOCs, EOGs,]
Include strategies that ensure
participation in high school
assessments.
2F. Describe how
 ESL, EC and testing staff collaborate
to train ACCESS for ELLs and
Alternate ACCESS for ELLs test
administrators, ensure that all ELLs
participate, ensure an appropriate
testing environment, handle materials
in a secure manner, conduct testing,
disseminate results, and archive data.
2G. Describe the process
 For documenting and monitoring
local/state testing accommodations for
ELLs.[This can include local policies
regarding MSL/Common Exam test
administration]
2H. Describe how
 ESL teachers are including WIDA
ELD Standards in lesson planning and
instruction
2I. Describe how
 Collaboration between ESL and
Content teachers enables ELLs to
access teaching and learning during all
classes.
2J. List
 On-going, formative assessments used
for ELLs. [Do not include EOGs, EOCs,
ACCESS for ELLs, or other summative statemandated tests]
3. BASIC (Core) LIEP Services
See Appendix XII for guidance
Directions: Using the constructs below, create a LIEP continuum rubric of services for your LEA and/or Charter. Consider the Criteria
for determining the category of service, the Context in which services are provided in the LEA/Charter, and the actual Menu/List of
Services that correspond to each category of service from the sample list below. Please specify how you are providing LIEP services
for ELL/AIG and ELL/EC students.
LIEP Continuum of Services Rubric (Indicate the name your LEA will use for each category or LIEP Services)
Category 1:
Category 2:
Category 3:
Criteria:
Context:
Services:
NC Title III Application for the 2015-2016 School Year, April 6, 2015
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4A. Professional Development Plan for 2014-2015
Describe the professional development plan for administrators, content teachers, ESL teachers, paraprofessionals, and other school or
community-based organizational personnel of sufficient intensity and duration to have a lasting impact on teachers’ performance in the
classroom. Sec. 3115 (c)(2)] For BASIC include PD for ALL STUDENTS and STAFF that relate to ELLs’ needs.
Basic/
Approximate
Participants
Title/Topic
Goal
Follow Up
Supplemental
Date(s)
WIDA ELD
ESL Teachers
Standards
General Ed
WIDA ELD
Teachers
Standards
[Rows may be added to this table. Click “Table”; add row.]
Has Professional Development data also been documented in the Title III Professional
Development Survey in PowerSchool.
Yes
No
4B. Professional Development Plan for 2015-2016
Describe the professional development plan for administrators, content teachers, ESL teachers, paraprofessionals, and other school or
community-based organizational personnel of sufficient intensity and duration to have a lasting impact on teachers’ performance in the
classroom. Sec. 3115 (c)(2)] For BASIC include PD for ALL STUDENTS and STAFF that relate to ELLs’ needs.
Basic/
Approximate
Participants
Title/Topic
Goal
Follow Up
Supplemental
Date(s)
WIDA ELD
ESL Teachers
Standards
General Ed
WIDA ELD
Teachers
Standards
[Rows may be added to this table. Click “Table”; add row.]
4C. How does the LEA analyze data to determine PD needs and evaluate if PD was effective?
Describe how the LEA develops a multi year PD plan based on your LEAs Data Reflection process. Include all the data sources
analyzed and your PD development process.
Type of Data
Outcome Data
Specific Data Analyzed
Results of Analysis*
Demographic
Data
Process Data
Other Data
PD Development Process:
NC Title III Application for the 2015-2016 School Year, April 6, 2015
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Optional
The data below contains information comparing the district rates for the identified elements in comparison to the
LEP subgroup.
Data Element
Retention Rate
AIG Enrollment
Identified as EC
Graduation Rate
% of students enrolled in
transitional 3rd grade
District Percentage
LEP Percentage
Results of Analysis
Supplemental Title III Program for ELLs 2015-2016
Title III of the ESEA
SUPPLEMENT, NOT SUPPLANT -- Federal funds made available under this subpart shall be used so as to supplement the level of
Federal, State, and local public funds that, in the absence of such availability, would have been expended for programs for limited
English proficient children and immigrant children and youth and in no case to supplant such Federal, State, and local public funds.
Section 3115(g) of Title III of the ESEA
Use the following four questions as a framework for making decisions regarding whether the use of Title III funds
violates the “supplement not supplant” requirement.
1. What is the instructional program/service provided to all students?
2. What does the LEA do to meet Lau v. Nichols requirements?
3. What services is the LEA required by other Federal, State, and local laws or regulations to provide?
4. Was the program/service previously provided with State, local, and Federal funds?
Source: U.S. Department of Education webinar conducted on December 11, 2008.
http://www.ncela.gwu.edu/files/uploads/12/SNS3_Requirements.pdf
5. Required Supplemental Title III Program Elements
Required by Title III of ESEA
5A. How is the Title III Application/Plan
developed?
 How are parents, teachers, and administrators
included in the development of the plan? Sec.
3116 (b)(5)
5B. Include the names, title, and role of each person involved in the completion of this application.
Name
JobTitle
Role in Appliaction/Plan
Development
[Rows may be added to this table. Click “Table”; add row.]
5C. What is included in the ANNUAL parent
notification for each ELL’s eligibility for participation in a
bilingual/ESL program? Sec. 3302 (a)(b )
NC Title III Application for the 2015-2016 School Year, April 6, 2015
Page 6 of 14


Ensure parents are notified within 30 days of 1st
day of school or 14 days after enrollment. AND
INCLUDE “Reason for LEP Identification, ELP
Level & status of academic achievement, method
of instruction, how student needs will be met and
how they will meet academic standards for
promotion and graduation, ELL exit criteria,
expected rate of graduation, and option to
decline a particular service” Sec. 3302 (a) (1-8)
5D. Describe the plan to monitor
 academic progress of MFLEPS for at least
two years
5E. Describe
 Use of a measurable standard for
evaluating oral and written responses to
certify that teachers of ELLs students in
language instruction educational programs
are fluent in English and have sufficient oral
and written skills. Sec. 3116(c)
[College degrees, licensure, VIF assurances, being a native
English speaker, or being born/educated/trained in the US are
not enough to sufficiently address this item. There must be
additional steps completed by your district in order to meet this
requirement.]
5F. Describe how
 The Private schools in your LEA are invited
to participate [Include how school are identified,
contacted and consulted within a timely manner, time
line, etc.]

Documentation is maintained. Submit a
sample copy of official correspondences with
this application. [Invitation letter and response to
letters of invitation]
[Sec. 3214 (h)(2)(A,B) LEAs must consult with nonpublic
schools to identify their LEP students and provide equitable
participation of eligible students within the LEAs attendance
area.]
5G. Explain


Are private school ELLs served by your
program?
If so, please describe the services and how
collaboration between private schools and the
LEA occurs
6. Title III Supplemental LIEP Services
LIST ALL LIEP SERVICES funded by Title III.
Choose or add services that are either totally funded by Title III or funded in part by Title III personnel delivering
or coordinating the event, as appropriate.
Title III Supplemental LIEP
Services
SAMPLE List of appropriate services.
Description of Service
(Skip any not provided.)
Explain how each service provided in this application is reasonable, necessary, and
supplemental to Basic LIEP services.
ELL PreK Services
NC Title III Application for the 2015-2016 School Year, April 6, 2015
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For LEP PreK students included in the Oct 1
Headcount
Additional Curriculum Support/
Activities
[SIOP lessons, integrated lessons with other
content areas, etc.]
Additional Collaboration with
Content Teachers
[SIOP coaches, Lead teachers, etc.]
Additional Interventions
[Extra tutoring, content support in L1 or L2,
newcomer services, etc.]
Extended School Year or School Day
[Summer programs, before/after school
opportunities, etc.]
Supplementing schools’ role in the
enrollment process and data collection
for Title III Reporting [e.g., intake office.]
Additional Parent Training [Not
provided to all parents; perhaps provided by a
Title III Parent Liaison]
Additional Materials [Content materials
in addition to content textbook, materials for
additional interventions or extended schooling,
etc.]
Additional Training for Staff [Extra
training and support for new ESL teachers,
SIOP coaches, Lead teachers, etc.]
Other
Budget 2015-2016
BASIC (Core) and Title III (Supplemental)
7. Use the table below or request permission to submit your existing format to document Basic Language
Instruction Educational Program (LIEP) staff for 2015-2016.


Include ONLY staff paid with LEA/Charter funds. Do NOT include, special services provided by non-recurring funds, such as
project grants and collaborative pursuits hosted by other agencies.
DO NOT use Title III funds for Basic LIEP services.
BASIC (Core) Language Instruction Educational Program (LIEP) for ELLs
School
Expected
# ELLs
# Staff for
BASIC LIEP
Role
(e.g., ESL, DL, TBI, Heritage Language) Teacher; Interpreter; Teacher Assistant; Tutor
(e.g., .25, .5, 1.5 etc.)
[Rows may be added to this table. Click “Table”; add row.]
NC Title III Application for the 2015-2016 School Year, April 6, 2015
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8. Use the table below to document use of Title III funding in 2015-2016.


Budget codes have been revised to provide clearer guidance for appropriate use of Title III funds.
Include a job description for each Title III funded staff. See samples in Appendices X and XI.
Title III Supplemental LIEP Services
Title III Role1
Budget Code
Assigned Location(s)
# of Staff
Purpose Code
PRC Code
104 or 111 Only
Object
Code
E.g., Title III Lead Teacher; Title III Parent
Liaison; Title III Tutor, Title III TA
Title III Supplemental LIEP Expenses Other than Staff
Include clear description of supplemental nature of all purchases.
Purpose1
Item
1
Title III PRC 104 and/or 111 funds may ONLY provide services and materials that are supplemental to the BASIC LIEP for ELLs. See
Appendices XI, XII and XII for special provisions included in the NCDPI Allotment manual.
Title III Carry-over Funds for Supplemental LIEP Services (If applicable)
Title III Role1
Budget Code
Assigned Location(s)
# of Staff
Purpose Code
PRC Code
104 or 111 Only
Object
Code
E.g., Title III Lead Teacher; Title III Parent
Liaison; Title III Tutor, Title III TA
Carry-over Funds forTitle III Supplemental LIEP Expenses Other than Staff (If applicable)
Item
Purpose1
1
Title III PRC 104 and/or 111 funds may ONLY provide services and materials that are supplemental to the BASIC LIEP for ELLs. See
Appendices XI, XII and XII for special provisions included in the NCDPI Allotment manual.
8A. Clearly define the supplemental nature of each technology purchase listed above. (If applicable)
NC Title III Application for the 2015-2016 School Year, April 6, 2015
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9. Complete the two tables below to document that Supplement Not Supplant requirements will be met.
Verify existing Basic LIEP services provided in 2014-2015 will not be supplanted with Title III funds 2015-2016.
9A. Existing BASIC (Core) Program AND Title III (Supplemental) Services in 2014-2015
Number of Positions/Jobs by Role
Fund Source
# ESL
Tchr(s)
e.g., 1.0 (1 full time staff in that cost objective) or .5 (50% in that cost objective)
# Title III Parent
#Interpreter(s)
Liaison(s)
# Title III
# Other
#TA(s) #Tutor(s)
BASIC ESL
Supplemental
Lead Tchr(s)
(List Role)
Outreach
Total #
Positions
State LEP
PRC 054
*All Other Funds
Title III
PRC 104
Title III
PRC 111
*Including, but not limited to local, state ADM, IDEA, and/or Title I funds.
9B. Summary of Proposed BASIC (Core) Program AND Title III (Supplemental) Services in 2015-2016
Number of Positions/Jobs by Role
Fund Source
# ESL
Tchr(s)
#
ESL
TA(s)
e.g., 1.0 (1 full time staff in that cost objective) or .5 (50% in that cost objective)
# Title III
# Extended
#
Parent
# Title III
Day or
# Other
#
Interpreter(s)
Liaison(s)
Lead
Extended
(List
Tutor(s)
BASIC ESL
Supplemental
Tchr(s)
Year
Role)
Outreach
Total #
Positions
State LEP
PRC 054
*All Other Funds
Title III
PRC 104
Title III
PRC 111
*Including, but not limited to local, state ADM, IDEA, and/or Title I funds.
10. Fiscal Requirements
Title III expenditures must meet federal fiscal requirements, including time and effort, equipment records,
detailed invoices, and documented internal controls of the LEA/Charter. This includes PRC 111 if the
LEA/Charter receives funding for significant increase of immigrant students
10A. Describe how time and effort is documented for any staff paid with Title III funds.
10B. Describe how the LEA maintains appropriate equipment records, annual inventories, and detailed
invoices, if applicable.
NC Title III Application for the 2015-2016 School Year, April 6, 2015
Page 10 of 14
Significant Increase of Immigrant Students
For Recipients of PRC 111 Funds Only
LEAs with a significant increase in immigrant children, as documented by the February 1, 2013 Immigrant Federal Data Collection,
may be eligible to receive PRC 111 funds. LEAs that qualify for these funds will be notified. [LEAs may be eligible for PRC 111 and/or
PRC 104 funding.]
11. If your LEA is eligible, explain how these funds will be used to provide enhanced instructional
opportunities for immigrant children. Sec. 3115 (e)
NC TITLE III LEA APPLICATION, 2015-2016 School Year
LEA _________Title III Statement of Assurances 2015-2016 Page 1 of 3
Contact Person:
Phone Number:
Email Address:
The Statement of Assurances and the Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion Lower Tier Covered Transactions must be signed by the LEA Superintendent and
received at the NC Department of Public Instruction on or before Monday, June 1, 2015.
Email a copy of the electronically signed assurances and certification regarding debarment, suspension,
ineligibility and voluntary exclusion only. Keep the original with your records.

Payments to be received under No Child Left Behind, Title III and its authorization (U.S.C. 6801 et seq., Sections 3101, 3102,
3114-3116, 3121-3129, and 3141) will be used solely for services benefiting children of limited English proficiency, consistent
with the purposes, requirements, and other conditions of use as stipulated under this program.

The number of limited English proficient (LEP) students generates a minimum of $10,000 for the LEA.

An LEA may only use funds under Title III, Part A to supplement the level of Federal, State and local public funds that, in the
absence of the Title III funds, would have been provided for programs for limited English proficient children and immigrant
children and youth (Section 3115(g))

As applicant, this district or consortium will abide by all assurances published under the above law with regard to all statutes related
to nondiscrimination and other compliance features listed in the federal Standard Form 424B as revised for Non-Construction
Programs, the federal Certification Regarding Lobbying, and the Federal Certification Regarding Drug-Free and Tobacco-Free
Workplace Requirements.

The participation of this district or school in this program will be conducted in accordance with all federal, state, and local laws and
all requirements set forth in policies and procedures as issued by the North Carolina Department of Public Instruction.
NC Title III Application for the 2015-2016 School Year, April 6, 2015
Page 11 of 14

All supporting documents for expenditures under Title III will be maintained on file in the business office of the school district in
an orderly manner to permit expenditures audit and will be made available to appropriate officials upon request.

Non-public schools in the local education agency (LEA) will be contacted yearly and given an equitable opportunity to participate
in the planning and development of the programs funded under Title III for the benefit of LEP children attending non-public
schools.

Local parents, teachers, administrators, supporting personnel, and other groups as may be deemed appropriate by the LEA or
charter school will participate systematically in the design, planning, and implementation of the Title III program.

Programs, strategies, and activities under the Title III grant will be scientifically-research based.

The LEA will provide the following information to parents of LEP children selected for participation in a language instruction
educational program via a uniform notification process in a language the parent can understand (3302):
1.
2.
3.
4.
5.
6.
7.
8.
Reasons for LEP identification
Level of English proficiency
Method of instruction
How the program will meet the educational needs of the child
Specific exit requirements
Expected rate of transition out of ESL; expected rate of graduation
Their rights to decline a type of ESL service
The failure of the LEA to make progress on annual measurable achievement objectives for their children.
NC Title III Application for the 2015-2016 School Year, April 6, 2015
Page 12 of 14
LEA _________Title III Statement of Assurances 2015-2016 Page 2 of 3

The applicant will comply with Title VI, Section 601, of the Civil Rights Act of 1964 (race, color, national origin); Section 504 of
the Rehabilitation Act of 1973 (handicapped); Title IX of the Education Amendments of 1971 (sex); the Americans with
Disabilities Act of 1990 and the Age Discrimination Act of 1975.

Funds will be used to build LEA capacity to continue to provide high-quality language instruction educational programs for LEP
students once the subgrants are no longer available.

All teachers in a Title III language instruction educational program for limited English proficient children are fluent in English and
any other language used for instruction.

To produce quality teachers in every classroom, the LEA will plan, implement, and evaluate an ongoing professional development
program for all teachers who have LEP and immigrant students in their classrooms.

The LEA will comply with the statutory mandate for reporting the adequate yearly progress made by LEP students in language and
academic content.

The LEA will assess annually the English proficiency of all LEP children.

Evaluations will be used to determine and improve the effectiveness of the LEA Title III program and activities for LEP and
immigrant students.

Evaluations will include a description of the progress made by children in meeting North Carolina academic content and student
academic achievement standards for each of the two years after exiting LEP identification.

If the LEA fails to make progress toward meeting annual measurable achievement objectives for two consecutive years, the LEA
will develop an improvement plan that will ensure it meets those objectives.
*I hereby certify that all facts, figures, and representations made in this application are true and correct to
the best of my knowledge, and the school board of the local school agency (or agencies if the application is for a
consortium) named in this application has/have authorized me as its/their representative.
________________________
Typed name of Superintendent
___________________________
____________
Signature of Superintendent
Date
NC Title III Application for the 2015-2016 School Year, April 6, 2015
Page 13 of 14
Certification Regarding
Debarment, Suspension, Ineligibility And Voluntary Exclusion
Lower Tier Covered Transactions
LEA _________Title III Statement of Assurances 2015-2016 Page 3 of 3
This certification is required by the regulations implementing Executive Order 12549, debarment and suspension, 34 CFR Part 85,
section 85.510, Participants’ responsibilities. The regulations were published as Part VII of the May 26, 1998 Federal Register (pages
160-192). Copies of the regulations may be obtained by contacting the person to whom this proposal is submitted. By signing and
submitting this proposal, the prospective lower tier participant is providing the certification set out below.
Website Reference for NC Debarred Vendors: http://www.doa.state.nc.us/PandC/actions.asp
1.
The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into, if it
is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies
available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies,
including suspension and/or debarment.
2.
The lower tier participants shall provide immediate written notice to the person to which this proposal is submitted if at any time the
prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed
circumstances.
3.
The terms “covered transaction,” “debarment,” suspended,” “ineligible,” “lower tier covered transaction,” “participant,” “person,” “primary
covered transaction,” “principal,” “proposal,” and “voluntarily excluded,” as used in this clause have the meaning set out in the Definitions and
Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for
assistance in obtaining a copy of those regulations.
4.
The lower tier participant agrees by submitting this proposal that should the proposed covered transaction be entered into, it shall not
knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded
from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated.
5.
The lower tier participant further agrees by submitting this proposal that it will include the clause titled “Certification Regarding Debarment,
Suspension, Ineligibility, and Voluntary Exclusion-Lower Tier Covered Transactions,” without modification on all lower tier covered
transactions and in all solicitations for all solicitations for lower tier covered transactions.
6.
A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not
debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A
participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not
required to, check the Non-procurement List.
7.
Nothing contained in the foregoing shall be construed to require establishment of system of records in order to render in good faith the
certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business dealings.
8.
Except for transactions authorized under number 5 of these instructions, if a participant in a covered transaction knowingly enters into a
lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this
transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction
originated may pursue available remedies, including suspension and/or debarment.
The lower tier participant certifies, by submission of this proposal, that neither it nor its principals are presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or
agency.
Where the lower tier participant is unable to certify to any of the statements in this certification, such prospective participants shall attach
an explanation to this proposal.
________________________
Typed name of Superintendent
___________________________
____________
Signature of Superintendent
Date
NC Title III Application for the 2015-2016 School Year, April 6, 2015
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