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HomeMy WebLinkAboutC02-103 CDPHE_grant appnppI 1r•AT1niu cnD r— ' • "a ` , i- "AXE SUHMITTED: Applicant jdentifier OSCH0023 �,DERAL ASSISTANCE ;. TVPE OF SUBMISSION 3. DATE RECEIVED BY STATE: State App !cation Identifier Applica; : on Preapplication Con5UUCtIUII l] Construction 4. DATE RECEIVED BY FEDERAL AG Federal Identifier X Nun -Construction Non -Construction 5. APPLICANT INFORMATION Legal Name: Health & Human Services, Eagle County Early Head Organizational Unit: Address (give city, county, state, and zip code) Name and telephone number of the person to be contacted on PO Box 660 matters 500 Broldway Kathleen Forinash 970-328-8858 Eagle, Y% 81631 Eagle Executive Director 6. EMPLOYER IDENTIFICATION NUMBER (EIN) 7. TYPE OF APPLICANT (enter appropriate letter in box) 10 8 4 6 0 0 0 7 6 2 A. State H. Independent School Dist. B. County I. State Controlled Institution of Higher Learning C. Municipal J. Private University 8. TYPE OF APPLICATION New Continuation Revision D. Township K. Indian Tribe E. Interstate L. Individual F. Intermunicipal M. Profit Organization If Revision, enter appropriate letter(s) in box(es):El El G. Special District N. Other (specify) A. Increase Award B. Decrease Award C. Increase Duration 9, NAME OF FEDERAL AGENCY D. Decrease Duration Other (specify): HHS - Administration for Children & Families 10.CATAL0G OF FEDERAL 9 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 i 15. ESTIMATED FUNDING 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? a. YES THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE a Federal $ 313,693 .00 TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON DATE b NO X� PROGRAM IS NOT COVERED BY E.O. 12372 OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW b Applicant $ 78,615 .00 c State $ •00 d Local $ .00 e Other $ .00 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? f Program Income $ .00 Yes If "Yes," attach an explanation. ID No g Total $ 392,308 .00 18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION ARE TRUE AND CT. THE DOCUMENT HAS BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH , ASSURANCES IF THE a Typed Name of Authorized Representative b Title v �. lephone number Michael Galla her Chairman Bo 970-328-8605 b Signature of Authori d rese JeAle Signed rat4RAa 0A_ 5 �o'� rAJ