Annual Performance Report Form under the Paul Douglas Teacher Scholarship Program

PAUL DOUGLAS TEACHER SCHOLARSHIP PROGRAM

PERFORMANCE REPORT INSTRUCTIONS

Fiscal Year 20XX

(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 July 1, 20XX to June 30, 20XX.

SUBMISSION OF REPORTS

The submission of reports will be accepted electronically. The signed cover sheet and report form may be saved as a pdf. file and sent to: Darryl.Davis@ed.gov.

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 regulations.gov during the public comment period for this collection of information.  If you have specific questions about the form, instrument or survey, please contact the U.S. Department of Education, 400 Maryland Avenue, S.W., Washington, DC 20202-4536.

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 June 30, 20XX.

2. Number of Recipients as of June 30, 20XX:

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 June 30, 20XX, were neither teaching nor 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 June 30, 20XX, 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 June 30, 20XX, 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 20XX:

1. Enter the total amount of principal repaid during the award year (July 1, 20XX-June 30, 20XX) under the scholarship repayment provisions (34 CFR 653.62).

2. Enter the total amount of interest repaid during the award year (July 1, 20XX-June 30, 20XX) under the scholarship repayment provisions (34 CFR 653.62).

3. System Generated Total.

3. Amount of principal as of June 30, 20XX:

1. Enter the total amount of outstanding principal as of June 30, 20XX 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 June 30, 20XX:

1. Enter the amount of principal written-off through June 30, 20XX.

2. Enter the amount of interest written-off through June 30, 20XX.

3. System Generated Total.

4. Number of scholar cases the state agency has partially or fully written-off through June 30, 20XX.

• 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 June 30, 20XX, while the data in items C.1-C.3 are data for the award year, i.e., July 1, 20XX through June 30, 20XX.

• 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 default 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 June 30, 20XX. 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 June 30, 20XX, 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 June 30, 20XX, 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 June 30, 20XX, 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 area, 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 June 30, 20XX, 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 June 30, 20XX, have repaid the full amount of the scholarship assistance they received.

3. Enter the number of scholars who, as of June 30, 20XX, 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 June 30, 20XX, 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 June 30, 20XX 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/2021

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