NDE 36-002
Nebraska Department of Education
Office of Accreditation, Accountability, and Program Approval
Rev. 2/2022
Page 3
I hereby attest that the information on this application and any related documents is true, complete and
accurate. I acknowledge that if my application is approved, I must enter into a contract with the Nebraska
Department of Education prior to receiving any funds. I certify that I intend to complete the eligible graduate
program on which my eligibility for this award is based and maintain certification and employment as a full-
time teacher in Nebraska for the time period equal to the number of years required for award forgiveness. If I
fail to meet the requirements of award forgiveness pursuant to Section 79-8,137.04 R.R.S., the award becomes a
loan and I agree to repay the loan in accordance with the laws and regulations of the Excellence in Teaching
Act.
United States Citizenship Attestation
For the purpose of complying with Neb. Rev. Stat. §§4-108 through 4-113, I attest as follows (choose one):
I am a citizen of the United States.
I am a qualified alien under the Federal Immigration and Nationality Act, my immigration status and
alien number are as follows:
and I agree to provide a copy of my USCIS documentation upon request.
I hereby attest that my response and the information provided on this form and any related
application for public benefits are true, complete, and accurate and I understand that this information
may be used to verify my lawful presence in the United States.
The completed application and all supporting documentation are to be submitted to the designated contact person at the
institution in which you are enrolled per instructions on their EETP information page accessed from the EETP Application
Information webpage at:
https://www.education.ne.gov/educatorprep/eetp-current-teachers/enhancing-excellence-in-teaching-program-application-page/
Applications submitted for consideration of an EETP loan will undergo an initial review by the institution in which you are
enrolled and will then be forwarded to the Nebraska Department of Education (NDE) for final review and approval.
I, as program chair or designated representative of the graduate program at the institution above, verify that the
applicant is a resident Nebraska student pursuant to Section 79-8,133 R.R.S. and is officially enrolled in the
institution and graduate program above as evidenced by the attached Program of Study.
Signature of Teacher Education Program Chair or a Designated Representative
It is the policy of the Nebraska Department of Education not to discriminate on the basis of gender,
disability, race, color, religion, marital status, age, or national origin or genetic information in its educational
programs, administration policies, employment or other agency programs.
This application is a public record.
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