A r c h i v e d  I n f o r m a t i o n

APPENDIX C

Recommended Application Forms

Schools and Libraries Universal Service Fund

Application for Eligible Services

FCC Form I

BLOCK 3: Supplemental Information

12.	Number of buildings to be served _____
	Number of rooms to be served directly or through internal connections _____
	Approximate number of students enrolled by the schools and/or persons served by the libraries to receive services under this application _____
	If the applicant is not an education or library governance entity with a defined geographical jurisdiction (for example, a school district or library system) requesting serices for all its schools or libraries, list the zip codes of all schools or libraries for which services are requested.

________	________	________	_______	________	________
________	________	________	_______	________	________
________	________	________	_______	________	________

[ Form I, Block 2: Services Requested				[ Form I, Block 4: Certifications, Signatures and Seal of Notary Public

This page last updated 8/10/97 (pjh).