| E-Rate Record Keeping Checklist |
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| Form 500 |
| Form Identifier:__________________ |
Date Submitted:__________________ |
| Applicant:___________________________ |
Contact:____________________________ |
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Copy of completed Form 500 with signatures |
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Verification of Form 500 receipt by the SLD |
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| Appeal information |
| Form Identifier:__________________ |
Date Submitted:__________________ |
| Applicant:___________________________ |
Contact:____________________________ |
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SLD communication notes (e.g., data entry or PIA requested support information) |
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