audit disallowances, loans and taxes. If yes, include an explanation in an attachment. e. Organizational Unit: Enter the name of the 21. Authorized Representative: To be signed and primary organizational unit, department or dated by the authorized representative of the division that will undertake the assistance applicant organization. Enter the first and last activity. name (Required); prefix, middle name, suffix. f. Name and contact information of person Enter title, telephone number, email (Required); to be contacted on matters involving this and fax number. A copy of the governing body’s application: Enter the first and last name authorization for you to sign this application as (Required); prefix, middle name, suffix, title. the official representative must be on file in the Enter organizational affiliation if affiliated with applicant’s office. (Certain federal agencies may an organization other than that in 7.a. require that this authorization be submitted as part of the application.) Telephone number and email (Required); fax number. 9. Type of Applicant: (Required) Select up to three applicant type(s) in accordance with agency instructions. A. State M. Nonprofit Government N. Private B. County Institution of Government Higher C. City or Education Township O. Individual Government P. For-Profit D. Special District Organization Government than E. Regional Small Organization Business) F. U.S. Territory or Q. Business Possession R. G. Independent School District Institution S. Historically H. Public/State Controlled Black Colleges Institution of and Higher Universities Education (HBCUs) I. Indian/Native T. Tribally American Tribal Controlled Government Colleges and (Federally Universities Recognized) (TCCUs) J. Indian/Native U. Alaska Native American Tribal and Native Government Hawaiian Serving than Federally Institutions Recognized) V. Non-US Entity K. Indian/Native W. Other (specify) American Tribally Designated Organization L. Public/Indian Housing Authority
audit disallowances, loans and taxes. If yes, include an explanation in an attachment. e. Organizational Unit: Enter the name of the primary organizational unit, department or division that will undertake the assistance activity. 21. Authorized Representative: To be signed and dated by the authorized representative of the applicant organization. Enter the first and last name (Required); prefix, middle name, suffix. Enter title, telephone number, email (Required); and fax number. A copy of the governing body’s authorization for you to sign this application as the official representative must be on file in the applicant’s office. (Certain federal agencies may require that this authorization be submitted as part of the application.) f. Name and contact information of person to be contacted on matters involving this application: Enter the first and last name (Required); prefix, middle name, suffix, title. Enter organizational affiliation if affiliated with an organization other than that in 7.a. Telephone number and email (Required); fax number. 9. Type of Applicant: (Required) Select up to three applicant type(s) in accordance with agency instructions. A. State Government B. County Government C. City or Township Government D. Special District Government E. Regional Organization F. U.S. Territory or Possession G. Independent School District H. Public/State Controlled Institution of Higher Education I. Indian/Native American Tribal Government (Federally Recognized) J. Indian/Native American Tribal Government than Federally Recognized) K. Indian/Native American Tribally Designated Organization L. Public/Indian Housing Authority M. Nonprofit N. Private Institution of Higher Education O. Individual P. For-Profit Organization than Small Business) Q. Business R. Institution S. Historically Black Colleges and Universities (HBCUs) T. Tribally Controlled Colleges and Universities (TCCUs) U. Alaska Native and Native Hawaiian Serving Institutions V. Non-US Entity W. Other (specify)
Application-Package.docx