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BUREAU OF INDIAN EDUCATION ADVISORY BOARD FOR EXCEPTIONAL (Bureau of Indian Affairs)

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OMB Control No. 1076-0179
Expiration 02/28/2021
BUREAU OF INDIAN EDUCATION
ADVISORY BOARD FOR EXCEPTIONAL EDUCATION
MEMBERSHIP NOMINATION FORM
Nomination Information
A. Nominations are requested from individuals, organizations, and federally recognized
tribes, as well as from State Directors of Special Education (within the 23 states in which
Bureau funded schools are located) concerned with the education of Indian children with
disabilities as described above.
B. Nominees should have expertise and knowledge of the issues and/or needs of American
Indian children with disabilities. Such knowledge and expertise are needed to provide
advice and recommendations to the BIE regarding the needs of American Indian children
with disabilities.
C. A summary of the candidate’s qualifications (resume or curriculum vitae) must be
included with the nomination application. Nominees must have the ability to (1) attend
in Advisory Committee meetings, (2) carry out committee assignments, (3) participate in
teleconference calls and work in groups.
D. The Department of Interior is committed to equal opportunity in the workplace and seeks
diverse Committee membership, however is bound by the Indian Preference Act of 1990
(Title 25, U.S.C. Section 472).
Objective and Duties
A. The Board provides guidance, advice and recommendations with respect to special
education and related services for children with disabilities in BIE funded schools in
accordance with the requirements of IDEA 2004;
B. The Board provides advice and recommendations for the coordination of services within
the BIE and with other local, State and Federal agencies;
C. The Board provides advice and recommendations on a broad range of policy issues
dealing with the provision of educational services to American Indian children with
disabilities;
D. The Board serves as an advocate for American Indian students with special education
needs by providing advice and recommendations regarding best practices, effective
program coordination strategies, and recommendations for improved educational
programming;
E. The Board provides advice and recommendations for the preparation of information
required to be submitted to the Secretary of Education.
Page 1 of 5
OMB Control No. 1076-0179
Expiration 02/28/2021
F. The Board provides advice and recommends policies concerning effective inter/intra
agency collaboration, including modifications to regulations, and the elimination of
barriers to inter/intra - agency programs and activities.
G. The Board reports and directs all correspondence to the Assistant Secretary – Indian
Affairs through the Director of the Bureau of Indian Education with a courtesy copy to
the Designated Federal Official (DFO).
Membership
A. The Board shall be composed of fifteen (15) members. The Assistant Secretary – Indian
Affairs may provide the Secretary of the Interior recommendations for the Chairperson.
However all board members will be appointed by the Secretary of the Interior as
required. Board members shall serve a staggered term of two years or three years from
the date of their appointment. The Secretary may remove members from the Board at any
time at his/her discretion.
B. As required by the IDEA 2004, the Board will be composed of individuals involved in or
concerned with the education and provision of services to Indian children with
disabilities. The Board composition will reflect a broad range of viewpoints and will
include at least one (1) member representing each of the following interests: Indian
persons with disabilities, teachers of children with disabilities, Indian parents or
guardians of children with disabilities, service providers, State Education Officials, Local
Education Officials, State Interagency Coordinating Councils (for states having Indian
reservations), Tribal representatives or tribal organization representatives, and BIA
employees concerned with the education of children with disabilities.
C. Members of the Board will not receive compensation, but will be reimbursed for travel,
subsistence and other necessary expenses incurred in the performance of their duties
consistent with the provisions of section 5703, title 5, of the United States Code.
D. A member may not participate in matters that will directly affect, or appear to affect, the
financial interests of the member or the member’s spouse or minor children, unless
authorized by the DFO. Compensation from employment does not constitute a financial
interest of the member so long as the matter before the committee will not have a special
or distinct effect on the member or the member’s employer, other than as part of a class.
The provisions of this paragraph do not affect any other statutory or regulatory ethical
obligations to which a member may be subject.
E. The Board meets at least twice a year, budget permitting, but additional meetings may be
held as deemed necessary by the Assistant Secretary or DFO.
Page 2 of 5
OMB Control No. 1076-0179
Expiration 02/28/2021
PLEASE FILL OUT FORM COMPLETELY
Note: Additional pages may be added for further explanation of any item. Reference the corresponding item number
for which the additional explanation is made.
1. Full Name:
2. Mailing Address: 3. City: 4. State: 5. Zip Code:
6. Primary Contact Phone Number:
( )
7. Secondary Contact Phone Number:
( )
8. Place of Employment
9. Work Address: 10. City: 11. State: 12. Zip Code:
13. Employment Title:
14. Work Telefax Number:
( )
15. E-mail address:
Note to Review Committee: Prior to submitting this nomination application, the above named individual must be contacted
regarding appointment to the Advisory Board. Do not make nomination until this person has been contacted and agreed to have
his/her name submitted to the Bureau of Indian Education.
16. If appointed this person will represent one of the following categories (check all
applicable):
_____ Indian persons with disabilities
_____ Teachers of children with disabilities
_____ Indian parents or guardians of children with disabilities
_____ Service providers
_____ State Education Officials
_____ Local Education Officials
_____ State Interagency Coordinating Councils (for states having Indian reservations)
_____ Tribal representatives or tribal organization representatives
_____ Bureau employees concerned with the education of children with disabilities
Page 3 of 5
OMB Control No. 1076-0179
Expiration 02/28/2021
17. What role would you recommend this nominee serve?
_____ Advisory Board Chairperson
_____ Advisory Board Member
18. Nominee’s experience with BIA funded schools: (check all applicable)
_____ BIE Day School
_____ BIE Boarding School
_____ Off-Reservation Boarding School
_____ Tribal Contract School
_____ Tribal Grant School
_____ Cooperative School
19. List nominee’s experiences related to the education of Indian infants, toddler, children
and youth with disabilities, in the past 10 years. Include time frames of experience or
employment, position titles, location of employment or organization involvement and a
brief description of duties. (Attach additional pages if necessary.)
20. Provide a list of current memberships or current affiliation with professional education
organizations, particularly special education organizations. Identify organization offices
held if applicable. (Attach additional pages if necessary.)
Page 4 of 5
OMB Control No. 1076-0179
Expiration 02/28/2021
21. Identify special interests, activities, awards (professional, educational and community)
related to the education of disabled Indian children (infants, toddler, children and/or
youth). (Attach additional pages if necessary.)
22. Nominee recommended by:
Name of Indian tribe, organization, individual (include position title) making nomination:
Address of Indian tribe, organization, individual making nomination:
City: State: Zip Code:
Signature of Authorizing Official:
Date of Signature: Phone (Area code + Number): Telefax (Area code + Number):
PAPERWORK REDUCTION ACT STATEMENT
This information is being collected to select individuals to serve on a Federal advisory committee, the
Advisory Board for Exceptional Children (aka Advisory Board for Exceptional Children). Response to this
request is required to obtain a benefit. You are not required to respond to this collection of information
unless it displays a currently valid OMB control number. This information will be used to determine the
eligibility and the ranking of the nominee. Public reporting burden for this form is estimated to average 1
hour per response, including the time for reviewing instructions, gathering and maintaining data, and
completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of
this form to Information Collection Clearance Officer – Indian Affairs, 1849 C Street, NW, MS-3642,
Washington, DC 20240.
Page 5 of 5
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Completed 19 July 2020

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