EANS I Program Application Form

Application for non-public schools to receive services or assistance through the Emergency Assistance to Non-Public Schools (EANS) program under the Coronavirus Response and Relief Supplemental Appropriations Act, 2021 (CRRSA Act).

Paperwork 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. The valid OMB control number for this information collection is 1810-0751. The time required to complete this information collection is estimated to average 2 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this collection, please write to: U.S. Department of Education, Washington, DC 20202-4537.

* Required

PART A: Cover Sheet

Include articles such as "A", "An", and "The" in the school name. Example: If the school name is "The Academy" the school begins with the letter T.

What is the First Letter of the Name of the School? * 1.

A - C

D - G

H - L

M - O

P - R

S - T

U - Z

3/24/2021

Name of School (A - C) * 2.

ABC of NC Child Develop. Ctr

Abundant Life Christian Academy (Onslow)

Abundant Life Christian Academy (Union)

Academy at New Life

Academy at SOAR

Academy of Coastal Carolina

Academy of Excellence

Academy of Hope

Accelerator School LLC

Adventist Christian Academy

Agape International Christian Academy

AHOP Christian Leadership Academy Inc.

Ahoskie Christian School

Alamance Christian School

Albemarle School

ALC Mosaic

Alex. Youth Net. Struc Day Sch

Alexander Children's Center

Alexander Christian Academy

Alexander Christian Academy at Hiddenite

Alexander Christian High School

Alexander Youth Network School

Al-Huda Academy

Al-Iman School

Anami Montessori School

Anchor Baptist Academy

Anderson Academy

An-Noor School

Annunciation Catholic School

Antioch Christian Academy

Arborbrook Christian Academy

Arden Christian School

Arendell Parrott Academy

Arthur Morgan School

Asheboro Hybrid Academy

Asherivan Entreleader Academy

Asheville Academy for Girls

Asheville Catholic School

Asheville Christian Academy

Asheville School

Asheville Waldorf School

Asheville-Pisgah Christian School

Assembly of Faith Chr. Sch.

Atlas International School

Auldern Academy

Back Creek Christian Academy

Bailey's Grove Baptist School

Bal Perazim Christian Academy

Berean Baptist Academy

Berean Christian School

Berean Junior Academy

Bethany Christian School (Davidson)3/24/2021

Bethany Christian School (Transylvania)

Bethel Assembly Christian Academy

Bethel Christian Academy (Avery)

Bethel Christian Academy (Haywood)

Bethel Christian Academy (Lenoir)

Bethesda Christian Academy

Bible Wesleyan Chr. Sch.

Bishop McGuinness Catholic H. S.

Black Mountain Academy

Black Mountain Montesorri

Blessed Sacrament Catholic School

Blue Ridge Adventist Christian School

Blue Ridge Christian School

B'nai Shalom Day School

Bonner Academy

Born Again Christian Academy

Bradford Academy

Bright Young Minds University

Brisbane Academy

British International Sch. of Charlotte

Brittain Academy

Brookhaven SDA School

Brookstone Schools

Building Blocks Montessori School

Burlington Christian Academy

C3 Concord Christian School

Caldwell Academy

Calvary Academy

Calvary Baptist Church School

Calvary Baptist Mission Academy

Calvary Chapel Academy

Calvary Christian Academy

Calvary Christian School (Franklin)

Calvary Christian School (Moore)

Calvary Christian School (New Hanover)

Calvary Christian School (Stokes)

Calvary Day School

Calvary Education Center

Camelot Academy

Cameron Boys Camp School

Cannon School

Canongate Catholic High School

Canterbury Classical School

Canterbury School

Canyon Hills Treatment Facility Academy

Cape Fear Academy

Cape Fear Christian Academy

Captain Gilmer Christian School

Cardinal Gibbons High School

Carmel Christian School

Carolina Adventist Academy

Carolina Baptist Academy

Carolina Christian Academy (Clay)

Carolina Christian Academy (Davidson)3/24/2021

Carolina Christian Academy (Lee)

Carolina Christian School

Carolina Day School

Carolina Dunes Academy

Carolina Friends School

Carolina Preparatory Academy

Cary Academy

Cary Christian School

Cathedral School

Cedar Forest Christian School

Cedar Fork Mennonite School

Cedarwood Academy

Champion Educational Center

Changing Hearts Boarding Sch.

Charity Christian School

Charlotte Catholic High School

Charlotte Christian School

Charlotte Country Day School

Charlotte Islamic Academy

Charlotte Jewish Day School

Charlotte Latin School

Charlotte Leadership Academy

Charlotte Preparatory School

Chesterbrook Academy of Cary

Chesterbrook Academy of Raleigh

Children's Discovery Center

Children's House Montessori Sch

Children's Schoolhouse

Chosen Generation Christ. Acad

Chowan Multi-Purpose Juvenile Sch

Christ Classical Academy

Christ Covenant School

Christ School

Christ the Cornerstone Academy

Christ the King Catholic High School

Christ the King Christian Academy

Christian Faith Center Academy

Christian Family Academy

Christian Life Academy

Christian Montessori School

Coastal Christian High School

Coastline Christian Academy

Columbus Christian Academy

Combine Academy

Commission Leadership Academy

Community Baptist Academy

Community Baptist School

Community Christian Academy

Community Christian School

Concord Academy

Concordia Christian Day School

Cornerstone Adventist Academy

Cornerstone Christian Academy (Catawba)

Cornerstone Christian Academy (Cumberland)3/24/2021

Cornerstone Christian Academy (Iredell)

Cornerstone Christian School

Cornerstone Treatment Facility

Covenant Classical School

Covenant Day School

Covenant Preparatory School

Cresset Christian Academy

Crossroads Christian School

Crossway Academy

Cumberland Co. Christian Sch.

Cyzner Institute

3/24/2021

Name of School (D - G) * 3.

Daniel Academy

Davidson Center for Learning

Davidson Day School

Davidson Green School

Del Mar Day Academy

Denver Christian Academy

Destiny Now Academy

Discovery Child Development Center

Dream Children School

Duke School

Durham Academy

Durham Nativity School

Dynamic Opportunities

Eagles Refuge Academy

Eliada Academy

Elizabethtown Christian Academy

Emerald School of Excellence

Emerson Waldorf School

Emmanuel Lutheran School

Empowered Minds Academy

Ephesus Junior Academy

Epiphany School of Charlotte

Epiphany School of Global Studies

Episcopal Day School

Evelyn Smith Wray Village School

F.A.C.T. Day Treatment School

Faith Academy

Faith Academy Christian School

Faith Assembly Christian Academy

Faith Baptist Christian School

Faith Christian Academy (Cabarrus)

Faith Christian Academy (Columbus)

Faith Christian Academy (Guilford)

Faith Christian Academy (Wayne)

Faith Christian School (Nash)

Faith Christian School (Randolph)

Faith Education Academy

Faith Fellowship School

Faith-Covenant Christian Academy

Falcon Christian Academy

Family Worship Minist. Chr. Academy

Father Capodanno School HS

Fayetteville Academy

Fayetteville Christian School

Fayetteville Street Christian School

Fellowship Baptist Academy

Fellowship Christian Academy (Moore)

Fellowship Christian Academy (Onslow)

Fellowship Christian School

First Assembly Christian School

First Impressions Academy

First United Methodist Kindergarten3/24/2021

First Wesleyan Christian School

Five Oaks SDA School

Five Points Education Training Cntr

Flaming Sword Christian Academy

Fletcher Academy (Henderson)

Fletcher Academy (Wake)

Fletcher School

Focus Academy at Overhills

Follow the Child Montessori School

Foreshadow Academy

Forsyth Country Day School

Foundations Christian Academy

Fox Flower Montessori School

Franciscan Catholic School

Freedom Academy

Freedom Christian Academy

French Broad River Academy - Boys

French Broad River Academy - Girls

Friends School

Friendship Christian School

Friendship Day Sch. for Sci. & the Arts

Fusion Academy and Learning Center - Charlotte

G.W. Taylor Instit. of Coll. & Car. Read

Galilee Christian Academy

Garnett Christian Academy

Gaston Christian School

Gaston Day School

Gateway Christian School

Genesis Academy

Gethsemane Christian Academy

Gethsemane Christian SDA Jr. Academy

Gift of Knowledge Academy

Glenwood Christian Academy

Global Montessori Academy

Goddard School

God's Heritage Christian Academy

Gorman Christian Academy

Gospel Light Christian School

Grace Academy (Union)

Grace Academy (Watuga)

Grace Baptist School

Grace Christian Academy (Alamance)

Grace Christian Academy (Cleveland)

Grace Christian Academy (Swain)

Grace Christian College Prep Acad

Grace Christian School (Lee)

Grace Christian School (Wake)

Grace Classical School

Grace Covenant Academy

Grace House Treatment Center

Grace Montessori Academy Incorporated

Grace Point Christian Academy

Gramercy Christian School

Great Accomplishments Academy3/24/2021

Greater Fayetteville Adventist Academy

Greater Vision Academy

Greenfield School

Greensboro Day School

Greensboro Islamic Academy

Greensboro Montessori School

Greenville Christian Academy

Greenville Learning Center

Greenville Montessori School

Greyfriars Classical Academy

Grove School of Cary

Guiding Light Academy

Guy Schools

3/24/2021

Name of School (H - L) * 4.

Halifax Academy

Hanger Hall School for Girls

Harrells Christian Academy

Harvest Preparatory Academy

Harvest Time Christian Academy

Haw River Christian Academy

Hawthorn Montessori School

Haywood Christian Academy

Hayworth Christian School

Heritage Christian Academy (Jackson)

Heritage Christian Academy (Wake)

Heritage Christian School

Heritage Hall International School

Heritage Leadership Academy

Heritage Leadership Academy - Durham

Heron Pond Montessori School

Hertford Multi-Purpose Juvenile Sch

Hickory Christian Academy

Hickory Day School

Hickory Grove Christian School

High Point Christian Academy

High Point Friends School

Highland Christian Academy

Highlander Academy

Hill Learning Center

Hill School of Wilmington

Hillsborough Christian Academy

Hilltop Christian School

Hobgood Academy

Holden Beach Christian Academy

Holy Trinity Catholic Middle School

Holy Youth Christian Academy

Hope Academy (Cabarrus)

Hope Academy (Guilford)

Hope Baptist Christian Academy

Hope Christian Academy

Hope Collegiate Academy

Hope Creek Academy

Hope Gardens Treatment Center

Hope Mennonite School

Hope Preparatory School

Imago Dei Classical Academy

Immaculata Catholic School (Durham)

Immaculata Catholic School (Henderson)

Immaculate Heart of Mary Cath Sch

Impact Journey School

Increase Learning Center

Independence Day Academy

Independence Montessori Academy

Infant of Prague Catholic School

Innovative Academy

Insight Colearning Center3/24/2021

Intellicor International Academy

International Montessori School

Iron Academy

Jackson Springs Treatment Facility

Jacksonville Christian Academy

Jarvisburg Christian Academy

Jefferson Day School

Johnathan's House Christian Acad

Jordan Lake School of the Arts

Ken Wheat Career Academy of Greensboro

Kent Academy

Kerr-Vance Academy

Kiddie Academy of Charlotte

Kids R Kids School

Kids R Kids School - Clayton

King Family Ministries Sch.

King's Academy

Knowledge Beginnings School

Knowledge Beginnings School - Raleigh

Knowledge is Power Early Lrng Prog

L & L Montessori School

Lake House Academy

Lake Norman Christian School

Laurinburg Institute

Lawrence Academy

Learn with the Best School

Learning Community Sch

Lee Christian School

Lee Park Preparatory School

Lerner School

Level Cross Christian School

Liberty Christian Academy (Cumberland)

Liberty Christian Academy (Onslow)

Liberty Christian School

Liberty Preparatory Christian Academy

LifeSpring Academy

Lionheart Academy of the Triad

Little Ivy Baptist Academy

Living Water Christian School

Living Word Christian Academy

Long Hill Christian School

Long Shoals Wesleyan Academy

Lucy Daniels Center

3/24/2021

Name of School (M - O) * 5.

Macon County Juvenile School

Male Leadership Academy of Charlotte

Mallard Creek Creativity Center

Manus Academy

Mariposa School

Marvin Academy

Matthews Christian Academy

Melmark Carolinas

Metrolina Christian Academy

Milestones Academy

Miller Creek Mennonite

Millers Creek Christian School

Millersville Christian Academy

Mills River Seventh-day Adventist

Mind and Soul School

Mintz Christian Academy

Miracle Tabernacle Academy

Miracle Tabernacle Christian Sch

Miss Charlie's Child Develop. Center

Mitchener University Academy

Montessori at Sandy Ford School

Montessori Children's School

Montessori Community School

Montessori Day School

Montessori Farm School

Montessori School of Durham

Montessori School of Raleigh

Montessori School of Winston-Salem

Morganton Day School

Mount Calvary Christian Academy

Mount Calvary Christian School

Mount Pisgah Academy

Mount Sheba Baptist Academy

Mount Zion Christian Academy (Durham)

Mount Zion Christian Academy (Robeson)

Mountain Pathways School

Mountain Sun Community School

Mud Creek Christian School

Murphy Adventist Christian School

My Dynamic Academy

Myrtle Grove Christian School

National Child Care Institute

Naturally Grown School

NC Boys Academy

NDC Academy

Nebo Crossing Academy

Nehemiah Enrichment Academy

Neuse Christian Academy

New Beginnings Christian School

New Bern Christian Academy

New City Christian School

New Classical Academy3/24/2021

New Garden Friends School

New Hope Christian Academy (Davidson)

New Hope Christian Academy (Duplin)

New Horizons Elem. School

New Independence Academy

New Kituwah Academy

New Life Academy

New Life Christian Acad & Prep Sch

New Life Christian Academy (Cabarrus)

New Life Christian Academy (Mecklenburg)

New Life Christian Academy (Nash)

New Life Christian Academy (Sampson)

New Manna Christian School

New School Montessori Center

New Vision Christian Academy

Newport Christian Academy

Next Generation Educ. Behav Ctr

Noble Academy

Norlina Christian School

North Hills Christian School

North Kannapolis Christian Acad

North Raleigh Christian Academy

North Shore Academy

Northeast Academy

Northside Christian Academy

Northview Baptist Academy

Northwood Temple Academy

Oak City Academy

Oak Level Baptist Academy

Oak Ridge Military Academy

Oakwood School

Oasis Performing Arts School

Odyssey Community School

Omega Academy

Omni Montessori School

One World Montessori LLC

O'Neal School

Onslow Christian Academy

Open Door School

Our Lady of Assumption Catholic School

Our Lady of Grace Catholic School

Our Lady of Lourdes Catholic School

Our Lady of Mercy Catholic School

Our Lady Perpetual Help Catholic School

Our Playhouse Preschool & Kindergarten

Outreach Academy

Outreach Christian Academy

3/24/2021

Name of School (P - R) * 6.

Palisades Episcopal School

Pamlico Christian Academy

Park Ridge Christian School

Parkway Christian School

Pathway Christian Academy

Pathways Mid. & Hgh. School

Paw Creek Christian Academy

Peace Montessori School

Peace Rose Montessori School

Peletah Academic Center for Excellence

Penderlea Christian Academy

Philips Academy

Phoenix Montessori Academy

Piedmont School

Pine Ridge Mennonite School

Pine Valley Wee Care Kindergarten

Pinewoods Montessori School

Point Institute

Pope John Paul II Catholic H. S.

Positive Day School

Precious Haven Learning Academy

Premier Service of Carolina Incorporated

Primrose School of Lake Norman

Primrose School of New Irving Park

Progressive Learning Academy

Prosperity Guidepost Montessori

Providence Day School

Providence Preparatory Academy

Providence: A Christ. Mon. Co

Pungo Christian Academy

Quality Education Institute

Quest Excellence Achieve. Acad

R. C. Smith Christian Academy

Rainbow Child Care Center

Rainbow Christian Academy

Rainbow Community School

Raleigh Christian Academy

Raleigh School

Raleigh SDA School

Ravenscroft School

Redeemer Preparatory Academy

Redeemer School

Reedy Fork Early Learning Academy

Reflections of Christ Christian Academy

Reimage Child Development Center

Renaissance Classical Academy

Renaissance Montessori Sch. of Cary

Resurrection Lutheran School

Reynolds Mountain Christ. Academy

Rhema Christian Academy

Ridgecroft School

Rise Academy Street School3/24/2021

Rising Stars Private School

Riverside Christian Academy (Cumberland)

Riverside Christian Academy (Robeson)

Robeson Multi-Purpose Juvenile Sch

Rockfish Christian Academy

Rockwell Christian School

Rocky Mount Academy

Rod of God Christian Academy

Roxboro Christian Academy

Royal Oak Cottage School

3/24/2021

Name of School (S - T) * 7.

Sacred Heart Catholic School

Saint Mary's School (Wake)

Salem Academy

Salem Baptist Christian School

Salem Christian Academy

Salisbury Academy

Salisbury Adventist School

Salisbury Christian School

Sandhills Classical Christian Sch.

School at Thompson

Scotland Christian Academy

Second Baptist Christian Academy

Sedgefield School

Severn Mennonite School

Shands School

Sheets Memorial Christian School

Shepherd Academy

Shiloh Institute of Learning

Shining Light Academy

Shining Light Baptist Academy

Shining Stars Academy

Silver Creek SDA School

South Charlotte Baptist Academy

Southeastern Autism Academy

Southeastern Christian Academy

Southlake Christian Academy

Southpoint Academy

Southport Christian School

Southside Christian School

Southview Christian School

Spirit of Life Christian Academy

Springs Academy

Spruce Pine Montessori School

St. Andrew's Episcopal School

St. Ann Catholic School (Cumberland)

St. Ann Catholic School (Mecklenburg)

St. Anne's Parish Day School

St. Catherine of Siena Cath Sch

St. David's School

St. Egbert Catholic School

St. Gabriel Catholic School

St. Gerard House

St. James Day School

St. John Paul II Catholic School

St. John's Lutheran Day Sch.

St. Joseph Academy

St. Leo Catholic School

St. Mark Catholic School (Mecklenburg)

St. Mark Catholic School (New Hanover)

St. Mary Catholic School (New Hanover)

St. Mary Catholic School (Wayne)

St. Mary Magdalene Catholic School3/24/2021

St. Mary's Christian Academy

St. Matthew Catholic School

St. Michael the Archangel Cath School

St. Michael's Catholic School

St. Patrick Catholic School (Cumberland)

St. Patrick Catholic School (Mecklenburg)

St. Paul Catholic Education Ctr

St. Peter's Catholic School

St. Pius X Catholic School

St. Raphael's Catholic School

St. Stephen's Lutheran School

St. SYA Academy II

St. Thomas More Academy

St. Thomas More Catholic School

St. Timothy's School

Star Christian Academy

Starboard Christian Academy

Statesville Christian School

Statesville Montessori School

Strait Path Academy

Straitway Baptist School

Strategic Academy (Mecklenburg)

Strategic Academy (Wake)

Summit School

Sure Promise Christian Academy

Swift Creek Mennonite School

T.A.P.S. Preparatory Academy

Tabernacle Christian School (Catawba)

Tabernacle Christian School (Union)

Teaching Achieving Students Academy

Temple Baptist School

Temple Christian School

Terra Ceia Christian School

Thales Academy

Thales Academy - Knightdale

Thales Academy Holly Springs PK5

Thales Academy JH/HS Apex

Thales Academy JHHS Rolesville

Thales Academy of Apex

Thales Academy of Raleigh

Thales Academy of Wake Forest

The Burlington School

The Covenant School

The Goodale School

The Halton School

The John Crosland School

The Master's Academy

The Nest Academy

The Point Christian Academy

The School of Hope

The Way Christian Academy

Third Street Academy

Tillery Christian Academy

Timbersong Academy3/24/2021

Timbersong Academy - Bat Cave

Topsail Montessori School

Treasures of Joy Christian Academy

Triad Baptist Christian Academy

Triangle Day School

Triangle Montessori Academy

Tri-City Christian Academy

Tri-City Christian School

Tri-County Academy

Tri-County Christian School

Trilogy School

Trimont Christian Academy

Trinity Academy of Raleigh

Trinity Baptist Academy

Trinity Christian Academy

Trinity Christian Preparatory School

Trinity Christian School (Pitt)

Trinity Christian School (Randolph)

Trinity Christian School (Rutherford)

Trinity Christian School of Fayetteville, Inc.

Trinity Episcopal School

Trinity of Fairview Academy

Trinity School of Durham & CH

True Abalities Lrng. Academy LLC

True Light Shines Academy

Tryon SDA School

Tutor All School

Tutorial -1/2 Christian Schools

TYCC Educational School

3/24/2021

Name of School (U - Z) * 8.

Union Grove Christian School

United Faith Christian Academy

Unity Christian Academy

University Christian High School

Upward Adventist School

Uwharrie Learning Center

Vandalia Christian School

Veritas Christian Academy

Veritas Collaborative School

Victory Baptist Church School

Victory Christian Academy (Columbus)

Victory Christian Academy (Gaston)

Victory Christian Academy (Rockingham)

Victory Christian Center School

Victory Christian School (Jackson)

Victory Christian School (Pasquotank)

Village Academy

Village Christian Academy (Cabarrus)

Village Christian Academy (Cumberland)

Wake Christian Academy

Wake Forest Montessori School

Wake-Up Learning Academy

Walters Grove Baptist Academy

Walton Academy

Wanchese Christian Academy

Waterview Learning Academy

Wayne Christian School

Wayne Country Day School

Wayne Montessori School

Wayne Multi-Purpose Juvenile Sch.

Weddington Christian Academy

Wescare Christian Academy

Wesleyan Christian Academy

West Christian Academy

West Duplin Christian Academy

WestCare N. Carolina Girls Sch.

Westchester Country Day School

WH Johnston SDA School

Whispering Pines Chr. Day Sch.

White Plains Christian School

Wilmington Academy of Arts & Sci

Wilmington Christian Academy

Wilmington SDA School

Wilson Christian Academy

Winston Salem Christian School

Winston-Salem Street School

Wolf Creek Academy

Woodland Baptist Chr. Sch.

Woodlawn School

Woodson Branch Nature School

Word of Faith Christian Sch.

Word of God Christian Academy3/24/2021

Yadkin Path Montessori

Yadkin Valley Community School

Yancey County Chr. School

Zelophehad's Daughters Christian Academy

To access funds, a non-public school must obtain a DUNS number at https://fedgov.dnb.com/webform/ (https://fedgov.dnb.com/webform/) and register with the System for Award Management (SAM) https://www.sam.gov/SAM/pages/public/generalinfo/aboutSAM.jsf (https://www.sam.gov/SAM/pages/public/generalinfo/aboutSAM.jsf) . A DUNS number will be required.

Does the School Have a DUNS Bradstreet Number? * 9.

Yes

No

The value must be a number

DUNS Bradstreet Number for School * 10.

(Street Number and Name, City, State, Zip Code)

Mailing Address of School * 11.

Full Name of Authorized Representative of the School * 12.

Email Address of Authorized Representative of the School * 13.

Please enter the telephone number using the format of (123) 456-7890

Telephone Number of Authorized Representative of the School * 14.

Full Name of a Secondary Authorized Representative of the School * 15.

Email Address of a Secondary Authorized Representative of the School * 16.

Please enter the telephone number using the format of (123) 456-7890

Telephone Number of a Secondary Authorized Representative of the School * 17.

3/24/2021

PART B: Non-Public School EligibilityAt its discretion, NCDPI may require a non-public school application to submit reasonable and appropriate documentation to substantiate one or more of these assurances.

NOTE: If a non-public school applies for a PPP loan on or after December 27, 2020, but does not receive funds under the PPP, the school may apply for services or assistance under the EANS program, as long as the non-public school meets the requirements and deadlines of this application. If a non-public school applied for or received a PPP loan prior to December 27, 2020, it remains eligible for the EANS program. Similarly, if a non-public school applies for but does not receive services or assistance through EANS, nothing in the Education Stabilization Fund would preclude the non-public school from applying for and receiving a PPP loan on or after December 27, 2020.

• The school requesting services or assistance is a non-profit school. • The school requesting services or assistance is accredited, licensed, or otherwise approved to operate in accordance with State law. • The school requesting services or assistance existed and operated prior to March 13, 2020. • The school requesting services or assistance did not and will not apply for and receive a loan under the Small Business Administration's Paycheck Protection Program (PPP) (15 U.S.C. 636(a)(37)) that is made on or after December 27, 2020. • None of the services or assistance for which I am requesting Support in Part D of this application have already been supported by a loan under the PPP.

By checking the box below, I affirm that the following statements are true and correct regarding my school * 18.

I affirm the above statements are true and correct regarding my school

3/24/2021

PART C: Non-Public School Data

Enrollment and Low-Income DataSection 312(d)(3)(C) requires NCDPI to prioritize services or assistance to non-public schools that enroll low-income students and are most impacted by COVID-19. Accordingly, the State requests that the school provide the data described below. Such data must not include personally-identifiable information about students or their families.

The NCDPI has discretion to identify the data source(s) it will accept when calculating the number of students enrolled in a non-public school in school year 2019-2020 who are from low-income families. NCDPI also has discretion in determining what it means for a family to have a low income (i.e., NCDPI sets a particular threshold, which could be a percentage of the Federal poverty level or another amount). NCDPI should make such information readily available and ensure that the definition of “low-income” it uses is the same for all non-public schools. NCDPI should select reliable source(s) of data that are least burdensome on non-public schools and families and may permit the use of multiple data sources.

To the extent non-public schools have the following readily available, possible data sources might include: • free or reduced-price lunch data, • scholarship or financial assistance data, • E-Rate data, or • other relevant data, such as data that the non-public school has provided to the State for purposes of State or local programs.

For non-public schools where such data are not readily available, and in order to avoid new or unnecessary data collections from non-public schools and families, the following are potential sources of estimates of the number of students from low-income families: • data imputing the number of students from low-income families based on the American Community Survey (ACS) or the Small Area Income and Poverty Estimates (SAIPE) program by the U.S. Census Bureau, or • proportionality data: the number of students enrolled in a non-public school who reside in a Title I school attendance area multiplied by the percentage of public school students in that same attendance area who are from low-income families. If the non-public school has students who reside in more than one Title I school attendance area, multiple calculations would be necessary.

Please enter a number greater than 0

Total student enrollment of the school in the 2019-2020 school year * 19.

Please enter a number greater than or equal to 0

Number or estimated number of students from low-income families enrolled in the school in the 2019-2020 school year * 20.

This number or estimated number is from the following data source(s) * 21.

Free or reduced-price lunch data

Scholarship or financial assistance data

E-Rate data

Other relevant data, such as data that the non-public school has provided to the State for purposes of State or local programs

Data imputing the number of students from low-income families based on the American Community Survey (ACS) or the Small Area Income and Poverty Estimates (SAIPE) program by the U.S. Census Bureau

Proportionality data: the number of students enrolled in a non-public school who reside in a Title I school attendance area multiplied by the percentage of public school students in that same attendance area who are fromlow-income families. If the non-public school has students who reside in more than one Title I school attendance area, multiple calculations would be necessary.

Unknown data

Other data sources (enter data source information below)

Other Data Source(s)22.

Number must be between 0 ~ 100

(i.e., Answer 14 divided by Answer 13)

Percentage or estimated percentage of total students in the school who are students from low-income families * 23.

3/24/2021

PART C: Non-Public School Data

Paycheck Protection Program (PPP)Section 312(d)(3)(C) requires NCDPI to prioritize services or assistance to non-public schools that enroll low-income students and are most impacted by COVID-19. Accordingly, the State requests that the school provide the data described below. Such data must not include personally-identifiable information about students or their families.

Did the school receive a loan guaranteed under the PPP before December 27, 2020? * 24.

Yes

No

Please enter a number greater than 0

What was the total amount of the PPP loan? * 25.

Do you certify that any funds received under the EANS program will be services or assistance not already funded by the PPP loan? * 26.

Yes

No

3/24/2021

PART C: Non-Public School Data

Coronavirus Relief Funds (CRF)Section 312(d)(3)(C) requires NCDPI to prioritize services or assistance to non-public schools that enroll low-income students and are most impacted by COVID-19. Accordingly, the State requests that the school provide the data described below. Such data must not include personally-identifiable information about students or their families.

Did the school receive Coronavirus Relief Funds (CRF)? * 27.

Yes

No

Please enter a number greater than 0

What was the total amount of the CRF funds received? * 28.

Do you certify that any funds received under the EANS program will be services or assistance not already funded by the CRF funds? * 29.

Yes

No

3/24/2021

PART C: Non-Public School Data

Impact of COVID-19Section 312(d)(3)(C) requires NCDPI to prioritize services or assistance to non-public schools that enroll low-income students and are most impacted by COVID-19. Accordingly, the State requests that the school provide the data described below. Such data must not include personally-identifiable information about students or their families.

Factors that NCDPI might consider in determining non-public schools that are most impacted by COVID-19 include but are not limited to: (1) loss of tuition revenue; (2) decrease in enrollment; (3) lack of capacity to provide remote learning due to insufficient technological support; and (4) data documenting the extent of learning loss attributable to the educational disruptions caused by COVID-19.

IMPORTANT: please limit response to 10,000 characters or less.

Describe and/or quantify the impact of COVID-19 on your school * 30.

3/24/2021

PART C: Non-Public School Data

Receipt of Equitable Services Under the CARES ActSection 312(d)(3)(C) requires NCDPI to prioritize services or assistance to non-public schools that enroll low-income students and are most impacted by COVID-19. Accordingly, the State requests that the school provide the data described below. Such data must not include personally-identifiable information about students or their families.

Did the school receive equitable services from an LEA under the CARES Act? * 31.

Yes

No

3/24/2021

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PART D: Non Public School Services or Assistance RequestedReimbursement for the expenses of any services or assistance described below that a non-public incurred on or after March 13, 2020 may not include the following: • Improvements to ventilation systems (including windows), except for portable air purification systems, which may be reimbursed. • Staff training and professional development on sanitization, the use of PPE, and minimizing the spread of COVID-19. • Developing instructional plans, including curriculum development, for remote or hybrid learning or to address learning loss. • Initiating and maintaining education and support services or assistance for remote or hybrid learning or to address learning loss. • Any expenses reimbursed through a loan guaranteed under the PPP (15 U.S.C. 636(a)) prior to December 27, 2020.

For additional information on allowable services or assistance, please see the Frequently Asked Questions posted online at https://oese.ed.gov/offices/education-stabilization-fund/emergency-assistance-non-public-schools/ (https://oese.ed.gov/offices/education-stabilization-fund/emergency-assistance-non-public-schools/)

Select one or more items below to apply for services or assistance to address educational disruptions resulting from COVID-19 * 32.

Supplies to sanitize, disinfect, and clean school facilities

Personal Protective Equipment (PPE)

Improving ventilation systems, including windows or portable air purification systems

Training and professional development for staff on sanitization, the use of PPE, and minimizing the spread of infectious diseases

Physical barriers to facilitate social distancing

Other materials, supplies or equipment recommended by the CDC for reopening and operation of school facilities to effectively maintain health and safety

Expanding capacity to administer coronavirus testing to effectively monitor and suppress the virus

Educational technology

Redeveloping instructional plans for remote or hybrid learning or to address learning loss

Leasing sites or spaces to ensure social distancing

Reasonable transportation costs

Initiating and maintaining education and support services or assistance for remote or hybrid learning or to address learning loss

I certify to the best of my knowledge and belief, all of the information in this application is true and correct. I further understand that knowingly making a false statement or misrepresentation on this application may subject me to criminal or civil penalties under applicable State and Federal laws. *

33.

Yes

No

Would the non-public school like to request a consultation to discuss the usage of EANS funds? * 34.

Yes

No

3/24/2021