________________________________________________

ATTACHMENT B

FLORIDA DEPARTMENT OF EDUCATION

TAPS Number

4A516

Please return to:

Florida Department of Education

Bureau of Grants Management

Room 332 Turlington Building

325 West Gaines Street

Tallahassee, Florida 32399-0400

Telephone: (850) 245-0496

Suncom:

A

)

Program Name:

Better Educated Students and Teachers (BEST)

Teaching Salary Career Ladder Pilot Program

DOE USE ONLY

Date Received

B) Name and Address of Eligible Applicant:

Project Number (DOE Assigned)

C

)

DOE USE ONLY

Total Approved Project:

$

D

)

Applicant Contact Information

Contact Name:

Mailing Address:

Telephone Number:

SunCom Number:

Fax Number:

E-mail Address:

CERTIFICATION

I, __________________________ (

Please Type Name)

do hereby certify that all facts, figures, and representations made in this

application are true, correct, and consistent with the statement of general assurances and specific programmatic assurances for this

e of

ate and

nation date of

ization

E)

Signature District Superintendent

DOE 100A

Revised 01/03

Page 1 of 2

Jim Horne, Commissioner

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Instructions for Completion of DOE 100A

A.

?

If not pre-printed, enter name of the program for which funds are requested.

B.

?

Enter name and mailing address of eligible applicant. The applicant is the public or non-public

entity receiving funds to carry out the purpose of the project.

C.

?

Enter the total amount of funds requested for this project.

D.

?

Enter requested information for the applicant’s contact person. This is the person responsible for

responding to all questions regarding information included in this application.

E.

?

The original signature of the District Superintendent is required.

•

?

Note:

Applications signed by officials other than the District Superintendent must have a letter

signed by the Superintendent, or documentation citing action of the governing body delegating

authority to the person to sign on behalf of said official. Attach the letter or documentation to the

DOE 100A when the application is submitted.

DOE 100A

Revised 01/03

Page 2 of 2

Jim Horne, Commissioner