Page 226 - E-Rate 2020-21 Workbook

INTERNAL CONNECTIONS
DEADLINE EXTENSION

REQUEST & AUTHORIZATION

Complete and return NO LATER than September 15 or 2 weeks prior to the deadline for installing your internal
connections. (Extensions are not available for maintenance or MIBS which must be completed by June 30)
School or Library Name:
Funding Year:
Funding Request Number:
Service Provider:
Short Description of
Services on this FRN:
√ REASON FOR EXTENSION. Please check any that apply:

Pending Service Substitution on this Funding Request
Pending Service Substitution on other FRNs related to this particular funding.
List associated FRNS:

Pending bond approval. Describe Situation:

Pending construction on new building. Provide Additional details:

Pending remodel of building. Provide additional details:

Pending decisions due to change of administration. Provide additional details:

Manufacturer delivery issues such as items backordered. Provide additional details:

Other (please describe)

I authorize Kellogg & Sovereign Consulting, LLC (KSLLC) to submit a service delivery deadline extension
request with USAC on our behalf.

Authorized Signature Date

Printed Name Title

Revised 7/10/2019 Kellogg & Sovereign® Consulting, LLC
Phone: 580‐332‐1444 KSPF03-July 2019