Application for Texas Classroom Connectivity Special Construction State Match CCI.B

Notification of Completion of Special Construction Project and USAC Disbursement of Special Construction Funding
County District Number*
CDN
School District Name or Consortium Name:*
Funding Year:*
Form 471 Application Number:*
471 Application Number
This school district or consortium has completed the Special Construction under the E-rate program. The school district or consortium has received disburement of funds for this project from the Universal Service Administrative Company (USAC) and submits this form to the Texas Education Agency (TEA) to request disbursement of Texas State Match funds in accordance with the Classroom Connectivity Initiative Grant.
Funding Request Number(s):*
FRN
FRN Number:
List additional FRN, if needed.
FRN Number:
List additional FRN, if needed.
Billed Entity Number (BEN):
District Billed Entity Number
Special Construction State/Tribal Match Percentage:*
(From your Special Construction FRN)
Superintendent's Name*

First NameLast Name
Superintendent's Email (Enter and confirm email address)*

Confirmation Emailexample@example.com
Certification:*
Date:*

MonthDayYear
Date
Applicant Notes:
Upload District's FCDL:*

Browse Files
Please upload your district's FCDL Cancelof
Contact Name:*

First NameLast Name
Contact Email (Enter and Confirm email address)*

Confirmation Emailexample@example.com
E-rate Consultant Name

First NameLast Name
E-rate Contultant Email (Enter and Confirm email address)

Confirmation Emailexample@example.com
Should be Empty:

Notification of Completion of Special Construction Project and USAC Disbursement of Special Construction Funding