Forms, Letters, & Checklists

Forms and letters are essential to communicating with the E-rate administrators. Here you will find a collection of forms and letters that are the most essential to the E-rate process. There are also checklists to help you with managing the E-rate process.

Application: California Teleconnect Fund

The California Teleconnect Fund (CTF) is a program established to make telecommunications services affordable for California schools, libraries, and other community-based non-profit organizations by offering a 50% discount on selected telecommunications services. The 50% CTF discount is applied after applying the FCC’s E-rate discount.

CIPA Compliance Documentation

Applicants that receive E-rate discounts for services other than basic telephone service (things like Internet Access, Internal Connections, or Basic Maintenance of Internal Connections) must certify on the Form 486 that they are in compliance with the requirements of the Children’s Internet Protection Act.

Missing USAC Correspondence

If you believe that you have not received correspondence from USAC (for example, related to the submission of a form or a quarterly report) you can request a copy of the correspondence to be resent to the applicant. In order to do so, you will need to contact the SLD, via the Client Service Bureau (1-888-203-8100), and request that these reports be resent to the school. When USAC resends the correspondence, it will be addressed to the original contact that was listed on the relevant applications. 

Checklist: Invoice Review

Applicants are required to review invoices before requesting reimbursement on the Form 472 (BEAR Form) to ensure that it is not asking for discounts on products or services that are ineligible for E-rate discounts and/or are not approved on the associated Funding Commitment. Funds For Learning provides this checklist as a guide when reviewing invoices.

Checklist: BEAR Preparation

This checklist will help you prepare your Forms 472 (Billed Entity Applicant Reimbursement) BEAR forms.

Checklist: Technology Planning

Funds For Learning has created this checklist to remind applicants of the major components that must be present in a technology plan, as well as some requirements for technology plans (as established by USAC).

Checklist: Typically Requested Services

Funds For Learning has compiled the following list of items that are typically purchased with E-rate discounts. This checklist is designed to remind applicants of common services and products purchased by many E-rate applicants.

Service Provider Evaluation Worksheet

This Sample Service Provider Evaluation Worksheet by Funds For Learning can help applicants in evaluating the bids and proposals they receive in response to a Form 470 posting. The below worksheet is for example purposes only, and as such, the existing evaluation criteria should be changed to reflect the evaluators own unique criteria.

Form 472 - Billed Entity Applicant Reimbursement Form

The Form 472, or Billed Entity Applicant Reimbursement Form, is completed by E-rate applicants to request reimbursement of approved, eligible expenses paid by the applicant. The service provider must also sign the form to indicate that it has provided, billed, and was paid by the applicant for approved, eligible services.

Template: Operational SPIN Change

The following template can be used to help you create an Operational SPIN Change request. The template uses Microsoft Word. You must have these software packages installed on your computer to use all of the features of the template.

Template: Service/Product Substitution

The following template can be used to help you create a service/product substitution request. The template uses Microsoft Word and Microsoft Excel. You must have these software packages installed on your computer to use all of the features of the template.

Form 470

Description of Services Requested and Certification Form

Form 471

Services Ordered and Certification Form 

Form 486

Receipt of Service Confirmation Form

The main purpose of the Form 486 is to notify USAC that services have begun on an approved funding commitment. The form is also where an applicant makes certifications related to their CIPA compliance and technology plan approval.

Form 500

Adjustment to Funding Commitment and Modification to Receipt of Service Confirmation

A Form 500 is filed by an applicant if it wants to do any of the following:

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