Records Code: XTAC
TEACH GRANT CERTIFICATION
Teacher Education Assistance for College and Higher Education (TEACH) Grant Program
Name
Address
City
State
Zip
Address
Email (Optional)
Telephone-Primary
Telephone-Alternate
SECTION 2: TEACH GRANT RECIPIENT'S UNDERSTANDINGS AND CERTIFICATIONS
I certify that:
(A)
(1) I am teaching or have taught full time as a highly-qualified teacher at a/an (check only one box):
Low-income elementary or secondary school
Low-income educational service agency
Elementary or secondary school
operated by the Bureau of Indian Education (BIE) or operated on an Indian reservation by an Indian tribal group under contract with the BIE.
Mathematics
Science
Foreign Language
Bilingual Education
English Language Acquisition
Special Education
Reading Specialist
(3) I am teaching or have taught at:
School Website
Address of School or Educational Service Agency
City
State
Zip Code
I must fulfill a teaching service obligation (service obligation) for each academic program for which I received a TEACH Grant, as stated in the
Agreement to Serve (Agreement) that I signed before receiving each TEACH Grant. If I do not fulfill my service obligation, all TEACH Grant funds
that I received will be converted to Federal Direct Unsubsidized Stafford/Ford Loans (Direct Unsubsidized Loans) that I must repay to the U.S.
Department of Education (the Department), with interest charged from the date of each TEACH Grant disbursement.
To fulfill my service obligation, I must teach full time for a total of at least four academic years within eight years after I complete or otherwise cease to
be enrolled in the program for which I received TEACH Grant funds. My teaching service must meet the requirements specified in Section 6 and in my
Agreement.
I understand that:
After completing each of the four academic years of required teaching service, I must provide my TEACH Grant servicer with documentation of my
teaching service by providing the information requested in Item A below and obtaining a certification in Section 3 of this form from the Chief
Administrative Officer for the school or educational service agency where I taught.
If I am not teaching, I must certify my intent to satisfy my teaching service obligation by checking the box in Item B below and signing the form. (If you
did not complete your TEACH Grant program of study, see Section 6.)
SECTION 1: TEACH GRANT RECIPIENT IDENTIFICATION Please enter or correct the following information:
Before completing this section, carefully read the entire form, including the instructions, definitions, terms and conditions, and important notices in
Sections 4, 5, and 6.
I taught full time for one complete academic year, as certified in Section 3 (if you check this box for this reason you must complete items 1,2 and 3
below, and sign the form. Your Chief Administrative Officer must complete Section 3.) Or
I am currently performing qualifying teaching service, but have not yet taught for a complete academic year (If you check this box for this reason
you must complete 1,2 and 3 below, and sign the form. If you did not complete the program for which you received your TEACH grants, your
Chief Administrative Officer must complete Section 3 and indicate that you have not taught a complete academic year using the check box
provided.)
(2) During the year of teaching listed below and as certified in Section 3, more than half of the classes I am teaching or have taught were in one
or more of the following high-need fields (check all that apply):
Name of School (Not School District) or Educational Service Agency at which I am teaching
Other high-need field (see Section 5; list the other high-need field and grade level taught):
SSN
-
-
(B)
(C)
(D) The information I provided in Sections 1 and 2 is true and correct.
(E) I have read and understand the definitions in Section 5 and the terms and conditions in Section 6.
(F) My teaching service met the requirements specified in Section 6.
TEACH Grant Recipient's Signature
Chief Administrative Officer only: I certify that the grant recipient identified in Section 1 taught during the academic year as a full-time highly-qualified teacher
(as defined in Section 5) from
Check here if certifying teaching service for less than a complete academic year.
Authorized Official only: I certify that the grant recipient identified in Section 1 is/was enrolled at
(Name of Institution) in an eligible program, as defined in Section 5 during the academic period from
date
to
date
.
Chief Administrative Officer/Authorized Official's Name and Title (Printed)
Telephone
Chief Administrative Officer/Authorized Official's Signature
Today's Date
• Type or print using dark ink. Enter dates as month-day-year (mm-dd-yyyy). Use only numbers. Example: January 31, 2013 = 01-31-2013.
• If you are certifying teaching service, the Chief Administrative Officer for the school or educational service agency where you performed your qualifying
teaching service must complete Section 3. If you taught at more than one school or educational service agency during the same academic year, you may
complete one certification form for each school or educational service agency at which you taught if one school or educational service agency cannot
certify your complete academic year of teaching.
• If you are certifying enrollment in an eligible program of study, an Authorized Official for the school at which you are/were enrolled in the eligible program
of study must complete Section 3.
Return the completed form and any attached pages to the address shown in Section 7.
Recipient Name
I did not complete my TEACH Grant-eligible program of study and am not teaching, but I have re enrolled in another eligible program of study, as
defined in Section 5. (If you check this box, sign the form and have an authorized official complete Section 3 to confirm your enrollment in an
eligible program. In addition, you may contact us to request a suspension of the eight-year period for completing your service of obligation).
I am not teaching, but I intend to satisfy my TEACH Grant service obligation. (If you check this box you only need to sign below)
SECTION 3: CHIEF ADMINISTRATIVE OFFICER or AUTHORIZED OFFICIAL'S CERTIFICATION
Before completing this section, carefully read the instructions, definitions, and terms and conditions in Section 4, 5, and 6. If recipient is teaching,
complete as Chief Administrative Officer. Return the completed form to the grant recipient identified in Section 1. If the recipient is enrolled in a
TEACH Grant eligible program of study, complete as Authorized Official.
at the eligible low-income elementary school, secondary school or educational service agency identified by the grant recipient in section 2, and that during this
year the grant recipient taught more than half of his or her classes in the high-need field(s) identified by the grant recipient in section 2.
SECTION 4: GENERAL INFORMATION AND INSTRUCTIONS
to
Todays date
Recipient SSN
-
-
click to sign
signature
click to edit
click to sign
signature
click to edit
SECTION 6: TEACH GRANT PROGRAM TERMS AND CONDITIONS
• In a high-need field (see Section 5) in more than half of the classes that you teach during each academic year.
An academic year or its equivalent is one complete elementary or secondary school year, or two complete and consecutive half-years from different school
years (excluding summer sessions) that generally fall within a 12-month period. If a school or educational service agency has a year-round program of
instruction, a minimum of nine months is considered to be the equivalent of an academic year.
• An authorized official who may complete Section 3 is an official of the school at which you are/were enrolled in a TEACH Grant-eligible program.
The Chief Administrative Officer for a school or educational service agency is the individual who has access to the employment records which establish that the
grant recipient’s teaching service met the requirements of the TEACH Grant Program, as explained in Section 6, and who is authorized to verify the grant
recipient’s qualifying teaching service. The Chief Administrative Officer may vary depending on the teacher’s employer, and could include (but is not limited to)
the principal or assistant principal of the school where the grant recipient taught, the superintendent, assistant superintendent, or human resources director for
a school district or educational service agency, or the chief executive officer of an educational services agency.
An eligible program of study is one that is TEACH Grant-eligible and is designed to prepare an individual to teach as a highly-qualified teacher in a high- need
field and leads to a baccalaureate or master’s degree, or is a post-baccalaureate program of study. A two-year program of study that is acceptable for full credit
toward a baccalaureate degree is considered to be a program of study that leads to a baccalaureate degree. An eligible program of study is also a program of
study that has been determined by a state to satisfy the requirements for certification or licensure to teach in the state’s elementary or secondary schools.
A high-need field includes the following: (1) bilingual education and English language acquisition; (2) foreign language; (3) mathematics; (4) reading specialist;
(5) science; (6) special education; and (7) any other field listed in the U.S. Department of education's (the Department's) annual Teacher Shortage Area
Nationwide Listing (Nationwide List).
Special education means specially designed instruction, at no cost to parents, to meet the unique needs of a child with a disability, including instruction
conducted in the classroom, in the home, in hospitals and institutions, and in other settings; and instruction in physical education, i.e., physical therapy. A child
with a disability is a child who needs special education and related services because the child has mental retardation, a hearing impairment (including
deafness), a speech or language impairment, a visual impairment (including blindness), a serious emotional disturbance, an orthopedic impairment, autism, a
traumatic brain injury, another health impairment, or a specific learning disability. For a child age 3 through 9, the term a child with a disability may, at the
discretion of the state and the local educational agency, include a child who needs special education and related services because the child is experiencing
developmental delays, as defined by the state and as measured by appropriate diagnostic instruments and procedures, in one or more of the following areas:
physical development, cognitive development, communication development, social or emotional development, or adaptive development.
A post-baccalaureate program of study is a program of instruction for individuals who have completed a baccalaureate degree that, (1) does not lead to a
graduate degree ; (2) consists of courses required by a State in order for a student to receive a professional certification or licensing credential that is required
for employment as a teacher in an elementary school or secondary school in that State, except that it does not include any program of instruction offered by a
TEACH Grant-eligible institution that offers a baccalaureate degree in education; and (3) is treated as an undergraduate program of study for the purposes of
title IV of the Higher Education Act.
A school or educational service agency serving low-income students (low-income school or low-income educational service agency) is an elementary
or secondary school or educational service agency that: (1) is in the school district of a local educational agency that is eligible for assistance under title I of the
Elementary and Secondary Education Act; (2) has been determined by the Department to be a school in which more than 30 percent of the school’s total
enrollment is made up of children who qualify for services provided under title I of the Elementary and Secondary Education Act; and (3) is listed in the
Department’s Annual Directory of Designated Low-Income Schools for Teacher Cancellation Benefits. All elementary and secondary schools operated by the
U.S. Department of the Interior’s Bureau of Indian Education (BIE) or operated on Indian reservations by Indian tribal groups under contract or grant with the
BIE qualify as low-income schools. If the school or educational service agency where you teach meets the low-income requirements during all or a part of a
school year of my required four school years of teaching, but does not meet those requirements in subsequent school years, those subsequent years of
teaching at that school or educational service agency will still qualify for purposes of satisfying my TEACH Grant service obligation.
• An elementary school is a nonprofit institutional day or residential school, including a public elementary charter school, that provides elementary
education as defined under State law.
A secondary school is a nonprofit institutional day or residential school, including a public secondary charter school, that provides secondary
education, as determined under State law, except that the term does not include any education beyond grade 12.
The Teacher Education Assistance for College and Higher Education (TEACH) Grant Program provides funds to students who are completing or who
plan to complete coursework that is required to begin a career in teaching.
A teacher is a person who provides direct classroom teaching or classroom-type teaching in a non-classroom setting, including special education teachers and
reading specialists. School librarians, guidance counselors, and other administrative staff are not considered teachers for the purposes of fulfilling the TEACH
Grant service obligation.
A full time teacher is a teacher who meets the standard used by a State in defining full-time employment as a teacher. For an individual teaching at
more than one school or educational service agency, the determination of full-time is based on the combination of all qualifying employment.
The highly-qualified teacher requirements are specified in section 9101(23) of the Elementary and Secondary Education Act of 1965, as amended,or,
for special education teachers, in section 602910) of the individuals with Disabilities Act.
For each academic program for which you receive TEACH Grant funds, you must complete a service obligation by teaching full time for a total of at least four
academic years:
As a highly-qualified teacher (see Section 5);
At a school or educational service agency serving low-income students (see Section 5); and
You must complete the required four years of teaching within eight years after you complete or otherwise cease to be enrolled in the program for which you
received the TEACH Grant.
SECTION 5: DEFINITIONS
• Bilingual education is an educational program in which two languages are used to provide content matter instruction. English language acquisition is the
process of acquiring English as a second language.
An educational service agency is a regional public multiservice agency authorized by State statute to develop, manage and provide services or programs to
local educational agencies, as defined in section 9101 of the Elementary and Secondary Education Act of 1965 as amended.
SECTION 7: WHERE TO SEND THE COMPLETED CERTIFICATION FORM
Return the completed form and any attachments to:
U.S. Department of Education
FedLoanServicing
P.O. Box 69184
Harrisburg, PA 17106-9184
or Fax to: 717-720-1628
If you need help completing this form, call:
1-800-699-2908
International: 717-720-1985
TDD: 1-800-722-8189
After completing each year of your required four years of teaching service, you must complete and submit this TEACH Grant Certification to the Department.
If you received a TEACH Grant but do not complete the required four years of teaching service within eight years of completing (or otherwise ceasing to be
enrolled in) the program for which you received a TEACH Grant, all TEACH Grant funds you received will be converted to Federal Direct Unsubsidized
Stafford/Ford Loans (Direct Unsubsidized Loans) that you must repay in full to the Department, with interest charged from the date of each TEACH Grant
disbursement you received.
If you received a TEACH Grant but did not complete your program of study, within 120 days of ceasing enrollment you must certify that you are employed as a
full-time teacher in accordance with the terms and conditions listed in your Agreement to Serve, or that you are not yet employed as a full-time teacher, but
you intend to meet the terms and conditions of your service obligation. If you do not meet one of these requirements, your TEACH Grant will be converted to a
Direct Unsubsidized Loan.
If you received a TEACH Grant but did not complete your program of study, within one year of ceasing enrollment you must re-enroll in a TEACH Grant eligible
program, begin creditable teaching service or be determined eligible for a suspension of your eight-year obligation period. If you do not meet one of these
requirements, your TEACH Grant will be converted to a Direct Unsubsidized Loan.
If you complete the academic program for which you received a TEACH Grant, you must actively confirm at least once each year that you intend to satisfy your
service obligation. If you do not actively confirm your intention, your TEACH Grant will be converted to a Direct Unsubsidized Loan.
You must maintain qualifying employment within a time-frame that allows you to complete your service obligation within the allotted eight-year period.
For complete terms and conditions of the TEACH Grant Program, see the TEACH Grant Agreement to Serve (Agreement) that you were required to sign before
you received a TEACH Grant.
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