Performance Report Instructions

PAUL DOUGLAS TEACHER SCHOLARSHIP PROGRAM

PERFORMANCE REPORT INSTRUCTIONS

Fiscal Year

(ED Form 40-31P, 84.176)

FREQUENCY OF REPORTS

The Paul Douglas Teacher Scholarship Performance Report is submitted once a year. This report covers Douglas scholars’ activities between XXXXX – XXXXXX.

SUBMISSION OF REPORTS

The signed original and one copy of the Paul Douglas Teacher Scholarship Performance Report should be sent to:

Ms. Shedita Alston

Paul Douglas Teacher Scholarship Program

OPE/PPI/Policy & Budget Development Staff

U.S. Department of Education

1990 K Street, NW, Room 6131

Washington, DC 20006-8524

Public Burden Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 12 hours per response, including 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 obtain or retain benefit under Title V Part C, Subpart 1 of the Higher Education Act of 1965, as amended (20 U.S.C. 1104 through 1104K). Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20202-4536 or email ICDocketMgr@ed.gov and reference the OMB Control Number 1840-0787. Note: Please do not return the completed Paul Douglas Teacher Scholarship Program Performance Report to this address.

SECTION I: Summary Repayment Information

All figures reported in a, b, and d, of this section are to represent the cumulative totals for all recipients as of XXXX.

2. Number of Recipients as of XXXX:

1. Enter the number of former Douglas scholars currently repaying their scholarship.

2. Enter the total number of former Douglas scholars who were in default (past due 180 days or more) on their repayment obligations.

3. Enter the total number of former Douglas scholars who were in deferment status.

4. System Generated Total.

2. Not in repayment status & not teaching:

1. Enter the total number of Douglas scholars who, as of XXXX, were neither teaching or in repayment status (as defined in 34 CFR 653.62(b)); and were still in school pursuing a course of study leading to a teacher certification.

2. Enter the total number of former Douglas scholars who, as of XXXX, were neither teaching nor in repayment status (as defined in 34 CFR 653.62(b)); and were no longer pursuing a course of study leading to a teacher certification. Include any Douglas scholars who were in a grace period, including the six-month grace period as defined in 34 CFR 653.62(b)(1)(i).

3. Enter the total number of former Douglas scholars who, as of XXXX, were neither teaching nor in repayment status (as defined in 34 CFR 653.62(b)); have completed their teacher certification course of study; have not yet begun to teach; and are in their allowed grace period.

4. System Generated Total.

3. Amount repaid during FY :

3. Enter the total amount of principal repaid during the award year (July 1, 2010-June 30, 2011) under the scholarship repayment provisions (34 CFR 653.62).

3. Enter the total amount of interest repaid during the award year (July 1, 2010-June 30, 2011) under the scholarship repayment provisions (34 CFR 653.62).

3. System Generated Total.

3. Amount of principal as of XXXXX:

1. Enter the total amount of outstanding principal as of XXXX, for the former Douglas scholars in repayment status. Include in this amount the accrued interest capitalized when the repayment schedules were established.

2. Enter the portion of the outstanding principal (reported in D.1. above) attributable to former scholars in default status.

3. Enter the portion of the outstanding principal (reported in D.1. above) attributable to former scholars in deferred status.

3. Amount of uncollectible debt written-off as of XXXX:

1. Enter the amount of principal written-off through XXXX.

2. Enter the amount of interest written-off through XXXX.

3. System Generated Total.

4. Number of scholar cases the state agency has partially or fully written-off through XXXX.

• Be sure that the data reported in items A.1-A.4, B.1-B.4, D.1-D.4, and E.1-E.4 are cumulative data as of XXXXX, while the data in item C.1-C-3 are data for the award year, i.e., XXXX through XXXX.

• Item D.1 should be the total amount of outstanding principal owed by scholars who are listed in item A.1., repayment status. Item D.2 should be the total amount of principal in defaulted owed by scholars who are listed in item A.2, default status. Item D.3 should be the total amount of principal in deferment owed by scholars who are listed in item A.3, deferment status.

SECTION II: Fulfillment of Scholarship Obligation

All figures reported in this section are to represent the cumulative totals as of XXXX. Report all scholars who have graduated (or who have taught or completed their teaching obligation) prior to as well as during the award year.

2. Completed the teacher certification course of study – Enter the total number of Douglas scholars who, as of XXXXX, have completed the postsecondary education degree program for which the scholarship was awarded.

2. Taught by grade level – Enter by grade level and type of institution, the number of scholars who, as of XXXX, have taught. If a scholar has taught at more than one grade level (or type of institution), indicate the most recent level (or type of institution) at which the scholar has taught. No scholar should be counted more than once.

3. Taught in teacher shortage area – Enter the total number of scholars, who, as of XXXX, have taught in a teacher shortage area, as defined in 34 CFR 653.50. If a scholar has taught in more than one type of shortage are, indicate the most recent type in which the scholar has taught. No scholar should be counted more than once.

3. Completed the scholarship obligation:

1. Enter the number of scholars, who, as of XXXX, have taught long enough to fully satisfy their teaching obligations, as required by 34 CFR 653.50.

2. Enter the number of scholars who, as of XXXX, have repaid the full amount of the scholarship assistance they received.

3. Enter the number of scholars who, as of XXXX, have completed their teaching obligation partially by teaching and partially through repayment.

4. System generated total.

E. Had the Scholarship obligation cancelled – Enter the total number of scholars who, as of XXXX, had their scholarship obligation cancelled because of death or disability

SECTION III: Summary Outcomes for All Former Scholars

All figures reported in this section are summations derived from the first two sections.

1. Not in repayment status and not teaching – System generated from Section I, B.4.

2. Teaching – System generated – Calculates the number of former scholars who were teaching as of XXXX, and did not fulfill the teaching/repayment obligation in prior years, i.e., ((Section II, B.4.A + B.4.B) minus (Section II, D.1 + D.3)).

3. In repayment status – System generated from Section I, A.4.

4. Completed or cancelled obligation – System generated – sum of Section II: D.4. plus E.

5. Written-Off – System generated from Section I, E.4.

6. Total – System generated total.

SECTION IV: Certification by Authorized Official

Be sure an authorized official of the agency signed and dated the report.

ED Form Number(s): 40-31P, 84.176

OMB NUMBER: 1840-0787

Expiration Date: XX/XX/XXXX

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