HomeMy WebLinkAboutC02-104 CDPHE_grant appAPPLICATION FOR F.DATE SUBMITTED:
FEDERAL ASSISTANCE
1. TYPE OF SUBMISSION WeTE RECEIVED BY STATE:
Application Preapplication
Construction Construction 4. DATE RECEIVED BY FEDERAL
X Non -Construction Non -Construction
5. APPLICANT INFORMATION
Legal Name: Health & Human Services, Eagle County Early Head
Address (give city, county, state, and zip code)
PO Box 660
500 Broadway
Eagle, CO 8 i 631 Eagle
6. EMPLOWR IDENTIFICATION NUMBER (EIN)
8 4 6 1 0 1 0 0 7 6 2
8. TYPE OF APPLICATION
aNew Continuation Revision
If Revision, enter appropriate letter(s) in box(es): E]
A. Increase Award B. Decrease Award C. Increase Duration
D. Decrease Duration Other (specify):
Applicant Identifier 08CH0023 C e t
State App _.��lfldentifier
Federal Identifier
Organizational Unit:
Name and telephone number of the person to be contacted on
matters
Kathleen Forinash
970-328-8858
Executive Director
7. TYPE OF APPLICANT (enter appropriate letter in box)
FB
A. State
H. Independent School Dist.
B. County
I. State Controlled Institution of Higher Learning
C. Municipal
J. Private University
D. Township
K. Indian Tribe
E. Interstate
L. Individual
F. Intermunicipal
M. Profit Organization
G. Special District
N. Other (specify)
9. NAME OF FEDERAL AGENCY
HHS - Administration for Children & Families
10.CATALOG OF FEDERAL g 3 6 0 0 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
DOMESTIC ASSISTANCE Eagle County Early Head Start
TITLE: Early Head Start Expansion - Ongoing
12. AREAS AFFECTED BY PROJECT
Eagle County, Colorado
13. PROPOSED PROJECT: 14. CONGRESSIONAL DISTRICTS OF:
Start Date Ending Date a Applicant 3rd District b. Project
8/01/2003 7/31/2004
16. ESTIMATED FUNDING 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS?
a Federal $ 313,693 .00 a. YES THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE
TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON
b Applicant
I $ 78,615 .00
DATE
b NO El PROGRAM IS NOT COVERED BY E.O. 12372
OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW
c State
$ .00
d Local
$ .00
e Other
S .00
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
f Program Income $ .00
Yes If "Yes," attach an explanation. El No
g Total S 392,308 .00
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION ARE TRUE AND CORRECT. THE DOCUMENT HAS
BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WI CHED ASSURANCES IF THE
a Typed Name of Authorized Representative b Title O� c� c Telephone number
Michael Gallagher Charon 970-328-8605
VA
b Signature ofAutho ed Repr e e * e Date Signed
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