Agency Form

If this grant uses a fiscal agent, the required materials are:

From the Fiscal Agent

From the agency:

Numbers 1-4 above

Any additional material may be supplied to the sponsor to be distributed at the presentation.

I confirm that all information I entered in this form is accurate and true.

I understand that the information in this form is not for public use and remains confidential depending on the agreement.

I certify that all purchases, invoices, certifications, financial statement, and other legal documents are thoroughly checked and make sure it is accurate.

I understand that the grant funds are given on a first-come basis.

I understand that the application will be reviewed and thoroughly evaluated based on the criteria of the grantor.

I release this company (grantor) and its employees from any liabilities, claims, and demands that may arise during this application.

By signing this form, you agree to the terms and conditions indicated on this form.