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)plleation for Federal .-4,........ Note: If available, please provide U.S. Department of Education f <br /> .:t.. Faso pproval f <br /> lUt;atlon Assistance /p . i �, package otMnr diskette OMB No. t17$-0106 <br /> - - J Exp.0650/2001 <br /> plicant Information <br /> ame and Address Organizational Unit <br /> p1Name City of Eugene <br /> Public Works Engineering <br /> ddress: 858 Pearl Street <br /> Eugene -OP 1anP g74nl - 2745 <br /> City State County ZIP Code + 4 <br /> ppliant's D -U-N -S Number. 1 1 1 2 1 1 0 1 4 1 5 1 6 1 3 1 7 I 6. Is the applicant delinquent on any Federal debt? Yes X No <br /> ppliaat's T - 1 - N 1 9 1 31 -1 610 1 012 1 1 1 612 1 al "Yu. "attach an J <br /> 1 Fund for the Improvement of Education <br /> ataiog of Federal Domestic Assistance 11: 84.2 1 1 1 5 1 $ 19 Earmarked A »! _ cat on <br /> roject Director: Scott Duckett 7. Type of Applicant (Enter appropriate letter in the boxy 1 C ; <br /> ddress: 858 Pearl Street A -State H- Independent School District <br /> B -County I - Public College or University <br /> Fugpne OR g74n1 27q5 C- Municipal J- Private, Non-Profit Cotkge or University <br /> ir/ State Zip code + 4 O - Township K - Indian Trbe <br /> d 541) fill? -.6842 .Fax 1:( 541) 682 - 5032 E- Inoastate L- Individual <br /> F - later M - Private, Profit-Making Organization <br /> %' R Scntt duckett@ci eugene or us G- SpeddOistrict N- Otlra ($pec�1: <br /> 8. Novice Applicant Yes X No <br /> plication Information <br /> ype of Submission: 12. Are any research activities involving human subjects planned at <br /> - Prapplication - Application any time during the proposed project period? X Yes No <br /> Construction Construction a. If 'Yes," Exemption(s) 1: 5 b. Assurance of Compliance 1: • <br /> Neon ,x_Non-Construction <br /> Fvaluatinn PrnjertOR <br /> k application subject to review by Executive Order 12372 process <br /> _ Yes (Date asade avallabk to the Executive Order 12372 c. IRB approval date: Full IRE pre <br /> process for review): I I - Expedited Review <br /> 13. Descriptive Title of Applicant's Project <br /> X No (T NA' check appropriate box bdowa Th West Eugene Wetlands Interpretive <br /> -X Program is not covered by E.O.12372 9 P <br /> Program has not been selected by state for review. . - Educational Plan (Project I EP ) <br /> Proposed Project Dates: _6_/1 —x1001 _5._' aj'nn2 . <br /> Start Data End Date: <br /> timated Funding Authorized Representative Information <br /> 15. To the best of my knowledge and belief, all data in this pr eppliation/application are true <br /> IL Federal S 128,000 .00 and contd. The document has ban duly authorized by the governing body of the applicant <br /> Applicant S - . 00 and the applicant will comply with the attached assurances if the assistance k awarded. <br /> State S - . 00 L Typed Name of Authorized Representative <br /> Local S - . 00 I PS A _ I y1 P <br /> Other S - -00 a. Tide: City Engineer <br /> • <br /> Program Income s - - 00 a Tel- l`: ( 541 ) 682 - 5291 Fax l`: ( 541 ) 682 5032 <br /> 4 E..m Add l es .a.lyle@ci.eugene.or.us <br /> TOTAL S . 128.000 .00 e. Signature of A Representative <br /> ED 424 (rev I l /12199) Date: ' l fge.. al — A. <br />