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Community Rehabilitation Program Application Form - Utah State Office Of Rehabilitation Page 7

CIVIL RIGHTS CERTIFICATE

ASSURANCE OF COMPLIANCE WITH TITLE VI OF THE CIVIL RIGHTS ACT OF 1964, SECTION 504 OF THE

REHABILITATION ACT OF 1973, TITLE IX OF THE EDUCATION AMENDMENTS OF 1972, AND THE AGE

DISCRIMINATION ACT OF 1975.

The applicant provides this assurance in consideration of and for the purpose of obtaining Federal grants, loan

contracts (except contracts of insurance or guaranty), property, discounts, or other Federal financial assistance to

education programs or activities from the Department of Education.

The applicant assures that it will comply with:

Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C. 2000d et seq., which prohibits

discrimination on the basis of race, color, or national origin in programs and activities receiving

Federal financial assistance.

Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits

discrimination on the basis of handicap in programs and activities receiving Federal financial

assistance.

Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1981 et seq., which prohibits

discrimination on the basis of sex in education programs and activities receiving Federal financial

assistance.

The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits

discrimination on the basis of age in programs or activities receiving Federal financial assistance.

All regulations, guidelines, and standards lawfully adopted under the above statues by the United

States Department of Education.

The applicant agrees that compliance with this Assurance constitutes a condition of continued receipt of Federal

financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees for the

period during which such assistance is provided. The applicant further assures that all contractors,

subcontractors, sub grantees or others with whom it arranges to provide services or benefits to its students or

employees in connection with its education programs or activities are not discriminating in violation of the above

statues, regulations, guidelines, and standards against those students or employees. In the event of failure to

comply the applicant understands that assistance can be terminated and the applicant may at its discretion seek

a court order requiring compliance with the terms of the Assurance or seek other appropriate judicial relief.

The person or persons whose signature(s) appear(s) below is/are authorized to sign this application, and to

commit the applicant to the above provision.

Date

Authorized Official(s)

Name of Applicant of Recipient

Street Address

City, State, Zip Code

Community Rehabilitation Program Application Form - Utah State Office Of Rehabilitation Page 7