Compliance with Children's Internet Protection Act (CIPA)
and E-Rate Funding 

Certification for "undertaking actions"
(In compliance with the requirements of CIPA)

I certify that, as of July 1, 2001 ( the date of the start of discounted services)

(School Name) ___________________________________________________________

has complied with FCC regulations with regard to CIPA by taking one or more of the following actions (please check all that apply):

_____ a. A published or circulated a board agenda with CIPA compliance cited as a topic.

_____ b. A circulated staff meeting agenda with CIPA compliance cited as a topic.

_____ c. A Service Provider quote requested and received which contains information on a Technology Protection Measure.

_____ d. A draft of an RFP or other procurement procedure to solicit bids for the purchase or provision of a Technology Protection Measure.

_____ e. An agenda or minutes from a meeting open to the public at which an Internet Safety Policy was discussed.

_____ f. An agenda or minutes from a public or nonpublic meeting of the local board at which procurement issues relating to the acquisition of a Technology Protection Measure were discussed.

_____ g. A memo to an administrative authority of a school corporation from a staff member outlining the CIPA issues not addressed by an Accessible Use Policy currently in place.

_____ h. A memo or report to an administrative authority of a school from a staff member describing research on available Technology Protection Measures.

_____ i. A memo or report to an administrative authority of a library from a staff member which discusses and analyzes Internet Safety Policies in effect at other libraries.

_____ j. We are already CIPA compliant. We use _________________________________

_____ k. Other________________________________________________________

_______________________________________________________________

(Authorized Signature) (Title) (Date)