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AIPPLICATION FOR OMB Approval No. 0348-0043 <br /> FEDERAL ASSISTANCE 2. DATE SUBMITTED Applicant Identifier <br /> ~ - 03 <br /> t. TYPE OF SUBMISSION: 3. DATE RECEIVED BY STATE State Application Ident~er <br /> I' tion Preapplication <br /> Construction ? Construction 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier <br /> Non-Construction Non-Construction <br /> 5r APPLICANT INFORMATION <br /> Legal Name: Organizational Unit: <br /> Address (g' a city, county, State, a zip code): Name and telephone number of person to be contacted on matters involvin <br /> Q~~' g pt~~ this application (give area apdej ,~wl+ Cof~ <br /> E' o SYl 6 a- S~.Y~ <br /> 6; EMPLOY IDE TIFICATION NUMBER (ElN): 7. TYPE OF APPLICANT: (enter appropriate letter in box) <br /> O O •Z 6 ~ A. State H. Independent Scholl Disl. <br /> 8~ TYPE OF APPLICATION: B. County 1. Slate Controtled InstRution of Higher Learning <br /> Q <br /> New ? Continuation ? Revision C. Municipal J. Private University <br /> D. Township K. Indian Tribe <br /> tf (Revision, enter appropriate letter(s) in box(es) ~ ~ E. Interstate L. Individual <br /> F. Intennunicipal M. Profd Organization <br /> A. Increase Award B. Decrease Award C. Increase Duration G. Speaai District N. Other (Specify) <br /> D. Decrease Duration Other(specify): <br /> 9. NAME OF FEDERAL AGENCY: <br /> Gt.S. ,Bu«w L~,t M~ <br /> 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: <br /> D ~ K ~ rah>., ~~Y ~-~•-.~f b, f~ f <br /> 12. AREAS AFFECTED BY PROJECT(Gities, C _ ties; Stafas,:eta): tr"nG, A.nCL.~vt~''"'~ ~ro~ ~.c~f <br /> 13. PROPOSED PROJECT 14. CONGRESSIONAL DI TS OF: <br /> Slari Date Ending Date a. Applicant b. Project <br /> 15. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE <br /> ORDER 12372 PROCESS? <br /> a. Federal S u •00 <br /> 1 D OD p a. YES. THIS PREAPPLICATIOWAPPLICATION WAS MADE <br /> b.',Applicanl S .00 AVAILABLE TO THE STATE EXECUTNE ORDER 12372 <br /> O d D PROCESS FOR REVIEW ON: <br /> c.'State S •00 <br /> DATE <br /> d.'Local S •00 <br /> b. No. ~ROGRAM IS NOT COVERED BY E. O. 12372 <br /> e.'Other S .00 ? OR PROGRAM HAS NOT BEEN SELECTED BY STATE <br /> FOR REVIEW <br /> f. Program Income S •00 <br /> 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT1 <br /> g. TOTAL S •00 <br /> a ~ ODD ? Yes H "Yes," attach an explanation. [~lo <br /> •t>!t. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATIOWPREAPPLICATION ARE TRUE AND CORRECT, THE <br /> DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE <br /> ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED. <br /> a. Type Name of Authorized Representative b. Title c. Tel phon Number <br /> L.~.n~S /K• lo( C~ Aa.a S~!! 1- 533 <br /> <br /> r d. na re of Authorized e. paj ig 3 <br /> ~ ~ <br /> rev' Edition Usable S andard Form 424 (Rev. 7-97) <br /> thorized for Local Reproduction Prescribed by OMB Circular A-102 <br /> <br />