NEBRASKA CRIME COMMISSION 2017 Community-based Juvenile Services Aid Enhancement [EB] Nebraska Revised Statute §43-2404.02 Section I: Applicant Information Telephone: ( ) Lead County/Tribe: Fax: ( ) Applicant Federal Employer ID: Address: Address of Applicant: City: State: Zip Code: – List of Partnering Counties/Tribes: Title of Project: Name: Telephone: ( ) Fax: ( ) Title: Project Director: Address: City: State: Zip Code: – Name: Telephone: ( ) Fax: ( ) Title: Project Coordinator: Email: Address: City: State: Zip Code: – Name: Telephone: ( ) Fax: ( ) Fiscal Officer: Email: Address: City: State: Zip Code: – Name: Telephone: ( ) Fax: ( ) Title: Authorized Official: Email: Address: City: State: Zip Code: –
NEBRASKA CRIME COMMISSION 2017 Community-based Juvenile Services Aid Enhancement [EB] Nebraska Revised Statute §43-2404.02 Section I: Applicant Information Lead County/Tribe: Telephone: ( ) Fax: ( ) Applicant Federal Employer ID: Address of Applicant: Address: City: State: Zip Code: – List of Partnering Counties/Tribes: Title of Project: Project Director: Name: Telephone: ( ) Fax: ( ) Title: Address: City: State: Zip Code: – Project Coordinator: Name: Telephone: ( ) Fax: ( ) Title: Email: Address: City: State: Zip Code: – Fiscal Officer: Name: Telephone: ( ) Fax: ( ) Email: Address: City: State: Zip Code: – Authorized Official: Name: Telephone: ( ) Fax: ( ) Title: Email: Address: City: State: Zip Code: –