Wayne County Community Development Block Grant Application FFY2022

Wayne County Community Development Block Grant Application FFY2022

Applications are due Friday, July 8, 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

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Name *

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

Wayne County Community Development Block Grant Application FFY2022

SIGNATURE

Certification