Application for State Grant Assistance

Please note: You will be required to attach the following documents in order to submit a complete application, so please be sure to have these readily available:

DCEO Mandatory Disclosure
DCEO Conflict of Interest Disclosure
Budget
Narrative (There is no template for this. You will create your own document. There is no limit on number of pages, spacing, font, etc...)

Below are additional documents for reference:

Should you have questions about this, please submit them here.

**Upon submission of this application, a confirmation email will be sent to the applicant via the email address entered for business/administrative office matters below.**

NOFO

Type of Submission

Type of Application

Name of Awarding State Agency

Catalog of State Financial Assistance (CSFA) Number

CSFA Title

Catalog of Federal Domestic Assistance (CFDA)

Not Applicable (No federal funding)

CFDA Number

CFDA Title

CFDA Number

CFDA Title

Additional CFDA Number, if required

Additional CFDA Title, if required

Funding Opportunity Number

Funding Opportunity Title

Competition Identification

Not Applicable

Competition Identification Number

Competition Identification Title

Applicant Information

Legal Name (Name used for DUNS registration and grantee pre-qualification) *

Common Name (DBA) *

Are you using an Employer Identification Number (EIN) or Taxpayer Identification Number (TIN)? *

EIN TIN

Employer Identification Number

Taxpayer Identification Number

Organizational DUNS Number *

SAM Cage Code *

Address *

Street Address

Street Address Line 2

City State

Zip Code

Applicant's Organizational Unit

Department Name *

Division Name *

Applicant's Name and Contact Information for Person to be Contacted for Program Matters involving this Application.

Name *

First Name Middle Name Last Name Suffix

Title *

Organizational Affiliation *

Phone Number *

Area Code Phone Number

Fax Number

Area Code Phone Number

Email Address *

example@example.com (Please note: This email will not be the one to receive the confirmation email upon submission. The next email entry will be.)

Applicant's Name and Contact Information for Person to be Contacted for Business/Administrative Office Matters involving this Application.

Name *

First Name Middle Name Last Name Suffix

Title *

Organizational Affiliation *

Phone Number *

Area Code Phone Number

Fax Number

Area Code Phone Number

Email Address *

example@example.com (This email will be the one to receive the confirmation of application upon submission.)

Areas Affected

Cities Affected by the Project (select all that apply) *