PART III. ACTIVITIES AND OPERATION INFORMATION
Physical location of the school itself_________________________________________________________
Yes
No
Is the school located within Indian Country?__________________________________________________
If yes, are the premises held in trust by the United States for the benefit of the tribe?___________________
Yes
No
Description of physical location of where the motor fuel is stored__________________________________
______________________________________________________________________________________
Yes
No
Does this organization purchase motor fuel in bulk which is then stored in fuel tanks?_________________
Are the fuel tanks where the fuel is being stored located on the school premises?_____________________
What is the motor fuel used in (i.e., equipment)?_______________________________________________
What vehicles is the motor fuel being consumed in?____________________________________________
______________________________________________________________________________________
For what purpose are the vehicles being used?_________________________________________________
Are any of the vehicles in which the motor fuel is consumed owned and licensed by the federal
government?_________________ If yes, please identify those vehicles and the license numbers
Yes
No
______________________________________________________________________________________
______________________________________________________________________________________
Description of funding for the school________________________________________________________
______________________________________________________________________________________
Is the funding provided by the Indian Self-Determination and Educational Assistance Act or any other
public funding?____________________ If yes, indicate what funding is received?___________________
Yes
No
______________________________________________________________________________________
I DECLARE under the penalties of perjury that I am authorized to sign this application on behalf of the
above organization and I have examined this application, including the accompanying statements, and to
the best of my knowledge it is true, correct and complete.
Signature
Title or Authority
Date
1.
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