A. APPLICANT AGENCY (NAME, ADDRESS, C. OFFICIAL AUTHORIZED TO SIGN TELEPHONE, APPLICATION E-MAIL) (NAME, TITLE, ADDRESS, TELEPHONE, B. TYPE OF AGENCY Public; Private Non-Profit; SIGNATURE Private Profit (circle one) 501 (c ) (3): YES NO _____________________________________________ (circle one) D. PROJECT DIRECTOR (NAME, TITLE, ADDRESS, E. FINANCIAL OFFICER TELEPHONE, E-MAIL) (NAME, ADDRESS, TELEPHONE, F. TYPE OF APPLICATION _______ NEW SERVICES G. TITLE OF PROJECT H. TYPE OF PROPOSAL STATEWIDE _____________ COMMUNITY-BASED ____________ I. GEOGRAPHIC AREA TO BE SERVED, TARGET POPULATION, AND ESTIMATED NUMBERS IMPACTED GEOGRAPHIC AREA (including county/counties): ZIP CODES OF AREA TO BE SERVED (OPTIONAL): DIRECT SERVICE: NUMBER OF CHILDREN B-5 TO BE SERVED: NUMBER OF PARENTS TO BE SERVED: NUMBER OF OTHER PARTICIPANTS TO BE SERVED: J. FEDERAL IDENTIFICATION NUMBER L. PROJECT COSTS (FEIN) 1. FUNDS $____________ REQUESTED $____________ 2. CASH $____________ 3. ESTIMATED IN-KIND $____________ 4. TOTAL COST K. APPLICANT’S FISCAL YEAR ABSTRACT: Please include a brief (100 words or less) overview of the project. Font size may be 10 point, if necessary, in this box. ATTACHMENT B: TABLE OF CONTENTS with SIGNATURE Table of Contents The following must be submitted in this order with page numbers added.
A. APPLICANT AGENCY (NAME, ADDRESS, TELEPHONE, E-MAIL) C. OFFICIAL AUTHORIZED TO SIGN APPLICATION (NAME, TITLE, ADDRESS, TELEPHONE, B. TYPE OF AGENCY Public; Private Non-Profit; Private Profit (circle one) 501 (c ) (3): YES NO (circle one) SIGNATURE _____________________________________________ D. PROJECT DIRECTOR (NAME, TITLE, ADDRESS, TELEPHONE, E-MAIL) E. FINANCIAL OFFICER (NAME, ADDRESS, TELEPHONE, F. TYPE OF APPLICATION _______ NEW SERVICES G. TITLE OF PROJECT H. TYPE OF PROPOSAL STATEWIDE _____________ COMMUNITY-BASED ____________ I. GEOGRAPHIC AREA TO BE SERVED, TARGET POPULATION, AND ESTIMATED NUMBERS IMPACTED GEOGRAPHIC AREA (including county/counties): ZIP CODES OF AREA TO BE SERVED (OPTIONAL): DIRECT SERVICE: NUMBER OF CHILDREN B-5 TO BE SERVED: NUMBER OF PARENTS TO BE SERVED: NUMBER OF OTHER PARTICIPANTS TO BE SERVED: J. FEDERAL IDENTIFICATION NUMBER (FEIN) L. PROJECT COSTS 1. FUNDS REQUESTED 2. CASH 3. ESTIMATED IN-KIND 4. TOTAL COST $____________ $____________ $____________ $____________ K. APPLICANT’S FISCAL YEAR ABSTRACT: Please include a brief (100 words or less) overview of the project. Font size may be 10 point, if necessary, in this box. ATTACHMENT B: TABLE OF CONTENTS with SIGNATURE Table of Contents The following must be submitted in this order with page numbers added.
CBCAP-RFP-FY2019-FINAL-6-4-18.docx