Wayne County Community Development Block Grant Application FFY2022

Wayne County Community Development Block Grant Application FFY2022

Applications are due Friday, August 5, 2022. To receive an offline application form, contact Katie Blake at (570) 877-9277 or kblake@hailstoneeconomic.com.
Please review these guidelines before submitting an application.
Name of Applicant (i.e. Municipality, Nonprofit Organization) *
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Contact Person *

First Name Last Name
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Tax ID# (EIN) *
President or Chairperson *

First Name Last Name
Project/Activity Name *
Total Project/Activity Budget *
Amount of Funding Requested *
Provide a brief description and history of your municipality/organization. *
Provide a brief description of the project/activity. *
What specific community needs does this project/activity address? *
What specific geographic area does this project/activity serve? *
Who is eligible to benefit from this project? How are participants and the public educated and informed about the project/activity? How many people will benefit? *
What are the specific goals of this project/activity? *
List all other funding related to the project/activity.
Who will be responsible for administration of this grant? Describe your staff's and organization's experience managing federal funding or similar projects. *
Which of the following CDBG objectives does this project meet? *

Benefit low- and moderate-income individuals Eliminate slums and blight Meet a need having a particular urgency
Explain how the project/activity meets this CDBG objective. *
When will the project begin and end? What are the key milestones for this project? *
For public services only: Is this a new program or service, or will there be a 25% increase in people served?

New program or service 25% increase in people served Not applicable
For construction projects only: Will the applicant's employees or volunteers perform work related to this project?

Yes - Paid by CDBG Yes - Paid by Other Funding Source No
For construction projects only: If your employees or volunteers will perform work related to this project, describe their specific responsibilities.
Do your facilities, policies, and operations comply with the Americans with Disabilities Act? *

Yes No
If no, explain.
Upload Articles of Incorporation (nonprofit organizations)

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Upload IRS Determination Letter (nonprofit organizations)

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Upload Most Recent Audit or Review *

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Upload Documentation of General Liability Insurance *

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Upload Documentation of Workers' Compensation Insurance *

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Upload Documentation of Fidelity Bond Coverage *

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Upload Detailed Project/Activity Budget and/or Cost Estimate *

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Upload Current Municipal or Organizational Annual Budget *

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Upload Resolution or Meeting Minutes Showing 1) Name of Person Authorized to Submit Application; 2) Amount of Funding Requested; and 3) Purpose of Funding *

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Upload Board of Directors List (nonprofit organizations)

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Upload Project Photographs, Funding Commitment Letters, or Other Relevant Information (optional)

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SIGNATURE

By signing this form, the undersigned acknowledges and certifies that they: 1) have read this application and its guidelines in their entirety; 2) will comply with all applicable laws and regulations, including but not limited to CDBG regulations, the Civil Rights Acts, the Fair Housing Act, and the Americans with Disabilities Act; and 3) are in compliance with 24 CFR Part 5 and 24 CFR Part 570.609, use of debarred, suspended, or ineligible contractors or subrecipients.
Certification

I hereby certify that the information contained in this application is true and correct to the best of my knowledge and that I am authorized to submit this application for CDBG funding.
Signature

Clear
Name *

First Name Last Name
Title *
Today's Date
Should be Empty:

Wayne County Community Development Block Grant Application FFY2022

SIGNATURE

Certification