STATE OF KANSAS DEPARTMENT OF SOCIAL AND REHABILITATION SERVICES APPLICATION FOR GRANT TECHNICAL COVER PAGE A. APPLICANT AGENCY (NAME, ADDRESS, TELEPHONE, C. OFFICIAL AUTHORIZED TO SIGN APPLICATION E-MAIL) (NAME, TITLE, ADDRESS, TELEPHONE, E-MAIL) SIGNATURE _____________________________________________ B. TYPE OF AGENCY Public; Private Non-Profit; Private Profit (circle one) D. PROJECT DIRECTOR (NAME, TITLE, ADDRESS, E. FINANCIAL OFFICER TELEPHONE, E-MAIL) (NAME, TITLE, ADDRESS, TELEPHONE, E-MAIL) F. TYPE OF APPLICATION ONE) ______NEW ______REVISION CONTINUATION OF________________________ (GRANT NUMBER) G. TITLE OF PROJECT H. REGION (Select one per application) Kansas City Northeast South Central Southeast West Wichita I. GEOGRAPHIC AREA TO BE SERVED & TARGET POPULATION J. ABSTRACT: Please include a brief (100 words or less) overview of the project. Font size may be 10 point, if necessary, in this box.
STATE OF KANSAS DEPARTMENT OF SOCIAL AND REHABILITATION SERVICES APPLICATION FOR GRANT TECHNICAL COVER PAGE A. APPLICANT AGENCY (NAME, ADDRESS, TELEPHONE, E-MAIL) C. OFFICIAL AUTHORIZED TO SIGN APPLICATION (NAME, TITLE, ADDRESS, TELEPHONE, E-MAIL) B. TYPE OF AGENCY Public; Private Non-Profit; Private Profit (circle one) SIGNATURE _____________________________________________ D. PROJECT DIRECTOR (NAME, TITLE, ADDRESS, TELEPHONE, E-MAIL) E. FINANCIAL OFFICER (NAME, TITLE, ADDRESS, TELEPHONE, E-MAIL) F. TYPE OF APPLICATION ONE) ______NEW ______REVISION CONTINUATION OF________________________ (GRANT NUMBER) G. TITLE OF PROJECT H. REGION (Select one per application) Kansas City Northeast South Central Southeast West Wichita I. GEOGRAPHIC AREA TO BE SERVED & TARGET POPULATION J. ABSTRACT: Please include a brief (100 words or less) overview of the project. Font size may be 10 point, if necessary, in this box.
SFY12FamilyResourceProjectGrantApplication.docx