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ipphcatlon or Federal N ote : I ava please prov J . S. Department of Education <br /> , y application package on dis <br /> . diskette For= Maw <br /> Wu CSt10I1 Assistance 6 - ' ` , is owl waif./ the file format <br /> OM No. 1125-0106 <br /> x.06/306001 • <br /> ►pplkant Information <br /> . Name and Address Organizational Unit <br /> UPI Name: City of ugene <br /> Public Works Engineering <br /> Address 858 Pearl Strppt <br /> Furipnp - OR I ane 97401 -___2225_ <br /> City State County ZIP Code +4 <br /> L Applicant's D-U: N-S Number: ( 1 1 2 1 110 I 4 1 5 1 63 17 1 6. is the applicant delinquent on any Federal debt? Yes X No <br /> (//~Yer. attach an explanation) <br /> Appliaat's -N 19 1 3� -I 610 10i2 111, 6121 <br /> L <br /> T• Fund for the Improvement of Education <br /> L Catalog o f Federal D o m e s t i c Assistance 8: 84. 2 I 1 15 1 L 14 Earmarked Application <br /> LPrgjoctDirector: Scott Duckett 7. Type of Applicant (Enter oppropr1ate klieg- in the box) (C i <br /> Address 858 Pearl Street A •State H- independent School District <br /> B -County 1- Politic College or Univusity <br /> .--Eugeria pR 97401 9795 C - Mwrkipd J - Private, Non - Profit College or University <br /> OW State Zipcodc +4 D- Township K- Indian Ube <br /> Tet.d :( 541)_682 --6RA9 .Faxlt:( 5411 682 - 5032 E Interstate L Iadividml <br /> F.& • M - Private, Profit -leg Organization <br /> E Address: Scntt duckett@ci e"genp or us o- SpeclaiDrstria N•Other l.Spoc{�J: <br /> 8. Novice Applicant Yes , jNo <br /> Application Information <br /> A.Type of Submission: 12. Are any research activities involving human subjects planned at <br /> 4Pe ppltoatl ore .Application any time during the proposed project period? X Yes No <br /> Co on Construction a. If"Yes," Exemption(s) 8: 5 b. Assurance of Compliance 8: <br /> 'Noa-Coastntction _Non-Coastructioa <br /> Fualila Prn j pctOR <br /> Mk application subject to.review by Executive Order 12372 process? <br /> Yes (Date made available to the Ereactirr &der 12372 C. IIt8 approval date: Full IRS gar <br /> process forreview): l / <br /> Review <br /> . . P. Descriptive X No (11"No."chitk appropriate boat below) T of Applicant's Project: <br /> „___ Program is mot cour=ted by E.o.123n. The West Eugene Wetlands Interpretive <br /> Program has act been selected by State for review. • Educational Plan (Project I EP ) <br /> ILProposed Project Dates: _fi_jJ_rjnn1 _5_130j? f1(19 - - <br /> Start Data End Date: - <br /> Estimated Funding Authorized Representative Information - <br /> IS. To the best of my knowledge and belief, all data in this preapplicatiadapplication are true <br /> Ida. Fode al S 1,8.000 .00 and correct. The document has ben duly authorized by the governing body of the applicant <br /> b. Applicant S , - . 00 and the applicant will comply with the attached assurances if the assistance is awarded. • <br /> e. Shoe S - . 00 a. Typed Name of Authorized Representative • <br /> e. Local S _ - . 00 • I PS A _ I yl p • <br /> a. Other S _ .00 b. Tid City Engineer <br /> • <br /> t Program Income S - . 00 c. Tel. 8: ( 541 ).682—:-: 5291 Vs:( 541 ) 682 • 5032 <br /> 4. k:4411 Aedress les.a.lyte@ci.eugene.or.us <br /> g. TOTAL S 128.000 .00 e. signature of A Representative - <br /> ED424 (rev 11/12199) - LlWe- • <br /> • <br />