Fillable FY __ REVISION United States Department of the (Muscogee)

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FY __ REVISION United States Department of the (Muscogee)

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FY __ REVISION
Part 1
United States Department of the Interior Bureau of Indian Affairs
Muscogee Creek Nation Education Contracts under Johnson-O`Malley Act
Application and Regulatory Reporting Requirement 25 CFR 273
1. Name of Public School District Contact Person:
________________
________________________________
Title:
_____________
___________________________________
Address: Address:
_______________________________________________
_
City: State: Zip:
Telephone No:
__________________________________
1. FY __ Eligible Student count ________ Date submitted to___________________________
Muscogee (Creek) Nation JOM Office
2. Revised Budget Amount $ Proposed Contract Period: ________________________
(Months)
Starting Date Ending Date
Sub-Contractor/ School District Certification Name & Title of Authorized School District Representative
The data in this application is true and correct,
____________________________________________
the document has been duly authorized by the Name
appropriate officials of the applicant and the
____________________________________________
applicant will comply with attached assurances Title
if assistance is approved. Signature: ___________________________________
Date: _______________________________________
Indian Education Committees: Certification Indian Education Committee Chairperson
The Indian Education Committee has Signature:_______________________________________
participated fully in the planning and
development of this contract application. Date:
__________________________________________
FOR INTERNAL USE ONLY
To be completed by Muscogee Creek Nation Manager Date Received: ______________________________
Certification: Forwarded: __________________________________
I certify the application has been reviewed
in accordance with standards set forth in Amount Approved: _______________________________
CFR, Johnson-O`Malley regulations, and
is hereby recommended for approval. Signature: ______________________________________
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Contract Revised Budget Summary
Muscogee Creek Nation JOM
Part II
OCAS
code
Category JUSTIFICATION
for budget increase or decrease
Original
budget
Revised
budget
100
Personnel / Salaries
(Payroll staff)
200
Fringe Benefits
300
Consultants/Contractual
Services
(Non-payroll staff, contract staff,
cultural instructors, presenters,
tutors)
400
Purchased Property Services
(Repair and maintenance services)
500
Other Purchased Services
(Student transportation, staff
travel, contracted food services,
postage, telephone, printing,
advertising, mileage)
600
Supplies & Materials
(Office, paper products, copier
supplies, student supplies, food &
milk, books, periodicals,
magazines, workbooks)
700
Property
(Equipment, audio visual,
computers, furniture)
800
Other Program Cost
(Due, fees, conference registration
fees)
800
IEC Cost
(Stipend, training/conference fees,
awards banquet, food cost,
incentives, IEC travel)
900
TOTALS
_________________________________________ ___________________________________________
JOM Committee Chairperson date School Administrator date
Page 2
Part III
Education Plan_______________________________________________________________
Instructions: Complete this section ONLY if the program goals and objectives will change due
to the budget revision. If no changes in program design are affected by the budget revision
please disregard this section.
1. Name of school / pre-school/ project site:__________________________________________________
2. No. of JOM eligible students to be served: Pre-K____ K-6____ 7-12_____
3. Length of Program: _____________ to ______________ (date)
4. Program and Staffing Needs 5. Educational Goals
6. Measurable Objectives 7. Activities
Page 3
F
Y_____ Budget Revision
M
uscogee Creek Nation Education Contracts
Under the Johnson O’Malley Program
Page
1
Part I Revision Signature Approval
2
Part II Contract Revised Budget Summary
3
Part III Education Plan- If Applicable
Please
Attach
Budget Revision
We thank you for your promptness upon completing your FY____ Budget
Revision. If you have any questions, please contact our office.
P
rogram Manager (918)732-7839
Administrative Assistant (918)732-7843
Field Specialist (918)732-7842
Field Specialist (918)732-7840
Regina Keith
Terry Fish
Billy Proctor
Brittany Kesler
Lesley Frank
Data Clerk (918)732-7841
Page 4
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FY __ REVISION United States Department of the (Muscogee)

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Completed 20 July 2020

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