Form 506 - Title Vii Student Eligibility Certification (Page 2 of 2) in pdf

Form 506 - Title Vii Student Eligibility Certification Page 2

PAPERWORK BURDEN STATEMENT

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of

information unless such collection displays a valid OMB control number. The valid OMB control number

for this information collection is 1810-0021. The time required to complete this portion of the information

collection per type of respondent is estimated to average: 15 minutes per Indian student certification

(ED 506) form; including the time to review instructions, search existing data resources, gather the data

needed, and complete and review the information collection. If you have any comments concerning

the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S.

Department of Education, Washington, D.C. 20202-4651. If you have comments or concerns regarding

the status of your individual submission of this form, write directly to: Office of Indian Education, U.S.

Department of Education, 400 Maryland Avenue, S.W., LBJ/Room 3E200, Washington, D.C. 20202-6335.

Charlotte-Mecklenburg Schools,

please submit a copy of the completed form to:

José Hernández-Paris

Diversity Specialist

Title VII Indian Education Program Director

Diversity Office

Smith Family Center

1600 Tyvola Road, C-13

Charlotte, NC 28210

980-207-9536 - Cell

980-343-1338 - fax

Courier # 670

Form 506 - Title Vii Student Eligibility Certification Page 2