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HomeMy WebLinkAboutC02-105 CDPHEPART I - FACESHEET ATTACHMENT4 /U-15 APPLICATION FOR FEDERAL ASSISTANCE I. TYPE OF SUBMISSIO It. (� Application ® Non-Constmction . DATE SUBMITTED TO CORPORATION FOP 3. a DATE RECEIVED BY STATE: 3.b. STATE APPLICATION IDENTIFIER: NATIONAL SERVICE (CNCS): - 1846000Z62 _ 4. a. DATE RECEIVED BY CNCS: 4.b. CNCS GRANT NUMBER: GH OISRWC0007 5. APPLICANT INFORMATION LEGALNAME: Eagle County Government NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS APPLICATION (give oRGANIZATIONALuNrr: Health& Human Services mea end.). NAME: Kathleen Forinash ADDRESS (g.&rest odo'rrs; coy, rnvny, stare ands/p code): TELEPHONENUMBER ( 970 ) 328 - 8858 . PO Box 660 Eagle; CO 81631 FAxMrMBER ( 970) 328 - 8809 INTERNETE-MAILADDRESS: volntrec@eagle—county.com 6. EMPLOYER IDENTIFICATIONNUMBER(EX): 7. TYPE OF APPLICANT :(enterappropriate Feuer a, bar) FBI 8 4- 6 10 1010 1 A61 2 A. State H. Independent School District 3. TYPE OF APPLICATION (Check appropriate box): - -]NEW ❑CONTINUATION B. County L State CootrolladI=timtionofHigherearn Ling C Municipal J. Private University -]REVISION- D. Township K. Indian Tribe E. Interstate L. Individual If Revision, enter appropriate Ieuer(s) in box(es): a ❑ F. Inlermmicipai M. Profit Organiation G. Special District N. Private Non -Profit Organization A. Increase Award B. Decrease Award C. Increase Duration - O. Other (speciIP) D. Decrease Donation E. Othcr (spec6): 9. NAME OF FEDERAL AGENCY: PNS Corporation for National Service '�. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANTS PROJECT: RSVP: 94.002 FGP: 94.011 SCP: 94.016 9 4 0 0 2 PNS - 15 Senior Demonstration: 94.015 100 Volunteers Homeland Security 12. AREASAFFECTEDBYPROJECF(Lia Citiu.Co l,t ..,tWs,etc): Eagle,Basalt, Eagle,.Gypsum, Minturn, RedCliff, Vail, McCoy, Bond, 13. PROPOSED PROJECT: START DATE: ENDDATE: I4. ESTIMATED FUNDING: 15.. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUnVE ORDER 12372 PROCESS7 a. FEDERAL S - 26,333.00 - a, YES. THIS PREAPPLICATTONAPPLICATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR b. APPLICANT S 2,955.00 REVIEW ON. DATE c. STATE S —0 b. NO. @ PROGRAM IS NOT COVERED BY E.O. 12372 ❑ OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR d. LOCAL $ —0— - REVIEW e. OTHER S —0 16. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? ❑ YES If"Yes," anach an explanation. ❑ NO f. TOTAL $ 29,288.00 17. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATIOWPREAPPLICATION ARE TRUE CT. TtIP DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNINGBODYOF THE APPLICANT AND n@APPLICANT WILLCOMPLY WITH THEATrA IF THE ASSISTANCE IS AWARDED. a. TYPED NAME OF AUTHORIZED REPRESENTATIVE: b. TITLE: O ONE NUMBER:Michae Gal la her Chairman, Board of Co s a 70-328-8605 {IGN O A rh a SICK Moditled Standard Pbun 424-1,16 S - eW/ITJ 11 rOLORTV