responsible or for which it receives financial assistance from the U.S. Department of Education or the Michigan Department of Education. Certification for Participation as Grant Member Partnerships must consist of a local or intermediate school district, high school, early/middle college, a public community college or university, and a business and industry partner. List all participating partnership members below. Signature by the authorized representative indicates that the grant member will work cooperatively with the administrative and fiscal agent for this project. Certification of Agency Designated as Administrative and Fiscal Agent for this Project: (Local or Intermediate School District ONLY) Legal Name of Agency: Signature: (Name and Title of Authorized Representative): District Code: Mailing Address: Signature: Date Signed: Telephone: Street: City, Zip: Name and Title of Contact Peron: Mailing Address (if different from agency address) Certification of Participating Agency: Legal Name of Agency: Signature: (Name and Title of Authorized Representative): District Code: Mailing Address: Signature: Date Signed: Telephone: Street: City, Zip: Name and Title of Contact Peron: Mailing Address (if different from agency address) Certification of Participating Agency: Legal Name of Agency: Name and Title of Authorized Representative) District Code: Mailing Address: Signature: Date Signed: Telephone: Street: City, Zip: Name and Title of Contact Peron: Mailing Address (if different from agency address) Certification of Participating Agency: Legal Name of Agency: Name and Title of Authorized Representative) District Code: Mailing Address: Signature: Date Signed: Telephone: Street: City, Zip: Name and Title of Contact Peron: Mailing Address (if different from agency address) Certification of Participating Agency: Legal Name of Agency: Name and Title of Authorized Representative) District Code: Mailing Address: Signature: Date Signed: Telephone: Street: City, Zip: Name and Title of Contact Peron: Mailing Address (if different from agency address) Certification of Participating Agency: Legal Name of Agency: Name and Title of Authorized Representative) District Code: Mailing Address: Signature: Date Signed: Telephone: Street: City, Zip: Name and Title of Contact Peron: Mailing Address (if different from agency address) Certification of Participating Agency: Legal Name of Agency: District Code: Name and Title of Authorized Representative)
responsible or for which it receives financial assistance from the U.S. Department of Education or the Michigan Department of Education. Certification for Participation as Grant Member Partnerships must consist of a local or intermediate school district, high school, early/middle college, a public community college or university, and a business and industry partner. List all participating partnership members below. Signature by the authorized representative indicates that the grant member will work cooperatively with the administrative and fiscal agent for this project. Certification of Agency Designated as Administrative and Fiscal Agent for this Project: (Local or Intermediate School District ONLY) Legal Name of Agency: District Code: Signature: (Name and Title of Authorized Representative): Mailing Address: Street: City, Zip: Signature: Date Signed: Telephone: Name and Title of Contact Peron: Mailing Address (if different from agency address) Certification of Participating Agency: Legal Name of Agency: District Code: Signature: (Name and Title of Authorized Representative): Mailing Address: Street: City, Zip: Signature: Date Signed: Telephone: Name and Title of Contact Peron: Mailing Address (if different from agency address) Certification of Participating Agency: Legal Name of Agency: District Code: Name and Title of Authorized Representative) Mailing Address: Street: City, Zip: Signature: Date Signed: Telephone: Name and Title of Contact Peron: Mailing Address (if different from agency address) Certification of Participating Agency: Legal Name of Agency: District Code: Name and Title of Authorized Representative) Mailing Address: Street: City, Zip: Signature: Date Signed: Telephone: Name and Title of Contact Peron: Mailing Address (if different from agency address) Certification of Participating Agency: Legal Name of Agency: District Code: Name and Title of Authorized Representative) Mailing Address: Street: City, Zip: Signature: Date Signed: Telephone: Name and Title of Contact Peron: Mailing Address (if different from agency address) Certification of Participating Agency: Legal Name of Agency: District Code: Name and Title of Authorized Representative) Mailing Address: Street: City, Zip: Signature: Date Signed: Telephone: Name and Title of Contact Peron: Mailing Address (if different from agency address) Certification of Participating Agency: Legal Name of Agency: District Code: Name and Title of Authorized Representative)
61c7_Competitive_Grant_App_606077_7.docx