Fax: Fax: Email: Email: Total combined Please indicate your applicant Total Funding number of students status: Amount Requested: of lead applicant Individual Applicant and/or partnership/ (Not to exceed $1,500,000) Consortium Applicant consortium: County of the Lead applicant: I hereby certify that I am the applicant’s chief school/administrative officer and that the information contained in this application is, to the best of my knowledge, complete and accurate. I further certify, to the best of my knowledge, that any ensuing program and activity will be conducted in accordance with all applicable Federal and State laws and regulations, application guidelines and instructions, Assurances, Certifications, and that the requested budget amounts are necessary for the implementation of this project. It is understood by the applicant that this application constitutes an offer and, if accepted by the NYS Education Department or renegotiated to acceptance, will form a binding agreement. It is also understood by the applicant that immediate written notice will be provided to the grant program office if at any time the applicant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. Title Authorized Signature (Chief School/ Administrative Officer) Name: Date: Phone number: Email address: Attachment II: Mandatory Requirements Certification By signing this form, the undersigned certifies it can provide and/or meet the mandatory requirements listed below and outlined in the RFP. Certification for (Insert Applicant Name) Included in Mandatory Requirement Explanation application? Application Cover Page: Signed Attachment I Yes Attachment I Mandatory Requirements Signed to certify that the application meets all mandatory Yes Certification: Attachment II requirements. Memorandum(s) of For consortium applicants only: An MOU between the lead Understanding (MOU): applicant and each consortium member must be Yes Attachment IV completed, signed and submitted. Signed Attachment V, certifying that STLE-D grant funding Assurance of Funding: is supplemental to, and does not supplant, other funding Yes Attachment V sources.
Fax: Fax: Email: Email: Please indicate your applicant status: Individual Applicant Consortium Applicant Total combined number of students of lead applicant and/or partnership/ consortium: Total Funding Amount Requested: (Not to exceed $1,500,000) County of the Lead applicant: I hereby certify that I am the applicant’s chief school/administrative officer and that the information contained in this application is, to the best of my knowledge, complete and accurate. I further certify, to the best of my knowledge, that any ensuing program and activity will be conducted in accordance with all applicable Federal and State laws and regulations, application guidelines and instructions, Assurances, Certifications, and that the requested budget amounts are necessary for the implementation of this project. It is understood by the applicant that this application constitutes an offer and, if accepted by the NYS Education Department or renegotiated to acceptance, will form a binding agreement. It is also understood by the applicant that immediate written notice will be provided to the grant program office if at any time the applicant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. Authorized Signature Title (Chief School/ Administrative Officer) Name: Date: Phone number: Email address: Attachment II: Mandatory Requirements Certification By signing this form, the undersigned certifies it can provide and/or meet the mandatory requirements listed below and outlined in the RFP. Certification for (Insert Applicant Name) Mandatory Requirement Explanation Included in application? Application Cover Page: Attachment I Signed Attachment I Yes Mandatory Requirements Certification: Attachment II Signed to certify that the application meets all mandatory requirements. Yes Memorandum(s) of Understanding (MOU): Attachment IV For consortium applicants only: An MOU between the lead applicant and each consortium member must be completed, signed and submitted. Yes Assurance of Funding: Attachment V Signed Attachment V, certifying that STLE-D grant funding is supplemental to, and does not supplant, other funding sources. Yes
nysed-rfp-gt-24.docx