Wayne County Community Development Block Grant Application FFY2023
Applications are due Friday, July 21, 2023. 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)
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Mailing Address
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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
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Total Project/Activity Budget
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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?
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What specific geographic area does this project/activity serve?
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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?
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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?
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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
Name
*
First Name
Last Name
Title
*
Today's Date
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