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<br /> y APPLICATION FOR OMB Approval No. 0348-0043 <br /> FEDERAL ASSISTANCE 2• DATE SUBMITTED Applicant Identifier <br /> ~-1-03 <br /> 1. TYPE OF SUBMISSiON• 3. DATE RECEIVED BY STATE State Application ident~er <br /> Von Preapplication <br /> Construction ? Construction 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier <br /> Non-Construction Non-Construction <br /> 5. APPLICANT INFORMATION <br /> ..Legal Name: Organizational Unit: <br /> G; ,ale, ~-bbc lcl o f kS ~ ar <br /> Address (g' a city, county State, zip oode): Name and teleptwne number of person to be contacted on matters invoivin <br /> 4~j ~ PLC( this appCigtion (give area. oodel iG w!} G'of~/ <br /> o SY[ 6 a- s~Yr <br /> !6. EMPLO IDE FlCATION NUMBER ([=1Nj: 7. TYPE OF APPUCANt: (enter ~ppropriafe lefler In box) <br /> ~ D O ~ 6 O A. State H. Independent Sctaol Dist <br /> 8. TYPE OF APPLICATION- B. County I. State Controlled Institution of Higher Learning <br /> ~ew ? Continuation ?Revision C. Muniapal J. Private University <br /> D. Township K. Indian Tribe <br /> ff Revision, enter appropriate letter(s) in box(es) ~ ~ E. Interstate L. Individual <br /> F. Intennunicipal M. Profit Organization <br /> A. Incxease Award B. Decrease Award C. Increase Duration G. Speaal District N. Other (Specify) <br /> D. Decrease Duraiion Other(specilyj: <br /> 9. NAME OF FEDERAL AGENCY: <br /> 10. CATALOG OF FEDERAL DOI+IESTIC ASSISTANCE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: <br /> D A K 17f0.~en•~~~/ ~-G~ ~A ~f~f <br /> TITLE: w; r ~.FC~ n~a r p - <br /> 12. AREAS AFFECTED BY PROJECT(Cftfes, `::Stal~s;efc:): G ny'1 ~C~~~ 1 /v~J <br /> • L~~ ~~-~r a <br /> 13. PROPOSED PROJECT 14. CONGRESSIONAL DI TS OF: <br /> Start Date Erxi'uig Date a. Appicant b• Project <br /> '~-~-03 l2-3D-o FO u,( o~l~ <br /> 15. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE <br /> ORDER 12372 PROCESS? <br /> ie. Federel S ~ <br /> I D ODD a. YES. THIS PREAPPLICATIOWAPPLICATION WAS MADE <br /> b. Applicant S .00 AVAILABLE TO THE STATE F~CECUTNE ORDER 12372 <br /> 30 a o PROCESS FOR REVIEW ON: <br /> o. State S °D <br /> DATE <br /> d. Local S <br /> b. No.PROGRAM IS NOT COVERED BY E. 0.12372 <br /> e S 0D ? OR PROGRAM HAS NOT BEEN SELECTED BY STATE <br /> FOR REVIEW <br /> f. Program Income S ~ <br /> 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br /> ro <br /> g. TOTAL S ~ a ~ ? Yes If "Yes," attach an explanation. [~lo <br /> ~O~ <br /> 18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLK;ATION/PREAPPLICATION 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 Number <br /> d. na re of Authorized e• ~ ~ 0 3 <br /> ev Edition Usable S ndard Form 424 (Rev. 7-97) <br /> thorized for Local Reproduction Prescribed by OMB Circular A-102 <br /> <br />