APPENDIX I Southeast Missouri Waste Management District District Grants Program FY2017-18 APPLICATION FORM (Place at the front of your packet) I. Project Information. 1. Name of Project: 2. Type of Project: 3. Project Description: 4. Indicate any other affiliated federal, state or local agencies funding this project: Profile 1. Name of Business or Organization: Tax Identification No.: Mailing Address: City: Zip: Phone: Fax: 2. Name of Authorized Official: Official Title: Address: City: Zip: Fax: 3. Type of Applicant: Individual Business Public Entity or Institution Non-Profit Organization (include legal status documentation)
APPENDIX I Southeast Missouri Waste Management District District Grants Program FY2017-18 APPLICATION FORM (Place at the front of your packet) I. Project Information. 1. Name of Project: 2. Type of Project: 3. Project Description: 4. Indicate any other affiliated federal, state or local agencies funding this project: Profile 1. Name of Business or Organization: Tax Identification No.: Mailing Address: City: Zip: Phone: Fax: 2. Name of Authorized Official: Official Title: Address: City: Zip: Fax: 3. Type of Applicant: Individual Business Public Entity or Institution Non-Profit Organization (include legal status documentation)