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QUALIFIED SCHOOL CONSTRUCTION BONDS PROGRAM <br />(QSCB) <br />APPLICATION FOR AUTHORIZATION <br />Submittal Date: Contact Person: <br />LEA: Title: <br />School: Address: <br />Address: City: <br />City: Phone/Fax: <br />^ New <br />^ Renovation/Addition E-mail: <br />Certification of Eligibility <br />The Board of Education of the above-named LEA certifies, through a board resolution <br />dated ,that the QSCB proceeds will be used as follows: <br />Note: A co o the resolution must accom an this a lication. <br />1. Construction, rehabilitation, or repair of a public school or for land acquisition for such a <br />facility (not land for a future project). <br />2. Provision of equipment to be used in the portion of the public school facility to be <br />constructed, rehabilitated, or repaired with QSCB funds (not personal computers or <br />similar technology). <br />Note: A copy of the proposed spending plan and project schedule must accompany <br />this application. <br />QSCB'S MUST BE ISSUED BY DECEMBER 31, 2009 <br />Board of Education County Board of Commissioners <br />Chair Chair <br />Secretary Clerk <br />Date Date <br />Please return original via certified mail post marked no later than July 31, 2009 to: <br />QSCB I <br />School Planning Section <br />North Carolina Department of Public Instruction <br />6319 Mail Service Center <br />Raleigh NC 27699-6319 <br />Attachment number 3 <br />Page 158 of 315 <br />F-7 <br />