Fatherhood Engagement Services RFP #190831006 Proposal Cover Sheet □ □ □ REGION 1 REGION 2 REGION 3 Bridgeport, Norwalk New Haven, Milford Middletown, Norwich, Willimantic □ □ □ REGION 4 REGION 5 REGION 6 Hartford, Manchester Waterbury, Danbury, Torrington New Britain, Meriden □ CTDOC Team Statewide Name of Agency: Address Application Contact Person: Contact Person Phone & Fax: Contact Person Email Address: This application must be signed by the applicant's executive director or other individual with executive oversight for agency services delivered in Connecticut By submitting this application, I attest that all the information included within the application is true. Signature: Date: Name (Printed): Title:
Fatherhood Engagement Services RFP #190831006 Proposal Cover Sheet □ REGION 1 Bridgeport, Norwalk □ REGION 2 New Haven, Milford □ REGION 3 Middletown, Norwich, Willimantic □ REGION 4 Hartford, Manchester □ CTDOC Team Statewide □ REGION 5 Waterbury, Danbury, Torrington □ REGION 6 New Britain, Meriden Name of Agency: Address Application Contact Person: Contact Person Phone & Fax: Contact Person Email Address: This application must be signed by the applicant's executive director or other individual with executive oversight for agency services delivered in Connecticut By submitting this application, I attest that all the information included within the application is true. Signature: Date: Name (Printed): Title:
FES_RFP_Proposal_Cover_Sheet.docx