Instructions

By signing and submitting this application, as the duly authorized representative of the applicant, you certify that the applicant is eligible to submit an application based on the eligibility criteria below.

a)Inability to certify - Your inability to provide the certifications listed below will not necessarily result in denial of a grant. You must submit an explanation of why you cannot do so. We will consider your explanation in determining whether to enter into this transaction. However, your failure to furnish an explanation will disqualify your application.

b)Erroneous certification - The eligibility criteria are material representations of fact upon which we rely in determining whether to enter into this transaction. If we later determine that you knowingly submitted an erroneous certification we may terminate this transaction for cause or default.

c)Notice of error in certification - You must provide immediate written notice to us if at any time you learn that certification of the eligibility criteria was erroneous when submitted or has become erroneous because of changed circumstances.

Eligibility Criteria

As the duly authorized representative of the applicant, I certify, to the best of my knowledge and belief, that the applicant:

Certification –Focus Area

Eligible programs are those that address one of the two focus areas:

  • Tier 1 Education, or
  • Tier 1 Veterans and Military Families – VetSuccess AmeriCorps

Certification – Type of Organization

The applicant organization is an eligible organization. This includes a public or private nonprofit organization, including labor organizations, faith-based and other community organizations; institutions of higher education; government entities within states or territories (e.g., cities, counties); Indian Tribes, partnerships and consortia; and intermediaries planning to subgrant funds awarded.The applicant organization has not been convicted of a Federal crime.

Any organization described in Section 501 (c)(4) of the Internal Revenue Code of 1986, 26 U.S.C.501 (c)(4) that engages in lobbying activities is not eligible to apply, serve as a host site for member placements, or act in any type of supervisory role in AmeriCorps programs.

Certification – Minimum Size Corps

The applicant organization, either by itself or through agreements with partner organizations, is submitting an application to support at least 20 member service years (MSYs). An application requesting fewer than 20 MSYs is not eligible for funding.

Certification – Minimum Organizational Capacity

The applicant organization has an A-133 Audit or an Independent Financial Audit and has experience in managing a state and/or federal grant.

Certification - Dun and Bradstreet Universal Numbering System (DUNS) Number and System for Award Management (SAM) Registration

The applicant organization has a DUNS number and an Employer Identification Number and is registered with the Systems for Award Management (SAM).

Certifications Signature

By signing this certifications page, you certify that the application being submitted is eligible based on the criteria listed in the Certifications section of this application and in the Notice. The Certifications are:

  • Certification: Focus Area

Tier 1 Education

Tier 1 Veterans and Military Families – VetSuccess AmeriCorps

  • Certification: Type of Organization
  • Certification: Minimum Size Corps

Number of MSYs being requested

  • Certification: Minimum Organizational Capacity
  • Certification: DUNS and SAM Registration

DUNS number

Organization Name:

Program Name:

Name of Authorized Representative:

Title of Authorized Representative:

Signature: / Date: