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} APPL~CAT~ON FOR OMB Approval No. 0348-0043 <br /> FEDERAL ASSISTANCE 2. DATE SUBMITTED Applicant Identifier <br /> ~ - 03 <br /> 1. TYPE OF SUBMISSION: 3. DATE RECEIVED BY STATE State Application Ident~er <br /> A li Son Preappligtion <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 /> . <br /> (i L <br /> Addr <br /> ss (g" a city, county State, a zip: code): Name and telephone number of person to be contacted on matters invoNin <br /> QCJ ~ p~a~l this application(give'arrea.oodej xw!} Corm <br /> SYt - Y( <br /> o a ~ <br /> E 6 ~ S <br /> 6. EMPLOY IDENTIFICATION NUMBER (E!N): 7. TYPE OF APPLICANT: (enti?r apprgpriate letterin, box) <br /> b o o t 6 o Dist. <br /> A. State H. Independent School <br /> 8. TYPE OF APPLICATION: B. County I. State Controlled Institution of Higher Learning <br /> [New ? Continuation ?Revision C. Municipal J. Private University <br /> D. Township K. Indian Tribe <br /> If Revision, enter appropriate letter(s) in box(es) ~ ~ E. Interstate L. Individual <br /> F. Intermunicipai M. Profit Organization <br /> A. Increase Award B. Decrease Award C. Increase Duration G. Special District N. Other (Specify) <br /> D. Decrease Duration Other(specify): <br /> 9. NAME OF FEDERAL AGENCY: <br /> 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: <br /> ~ ~ x t~ ra b., ~'~Y ~-~•-•d f~A oaf <br /> tt A' - ~ <br /> TITLE: W l' i / ~'l(,Z~'r Q _ <br /> 12. AREAS AFFECTED BY PROJECT(~ties, Cottiitie~::Stalds;.eto.): ~nYl q,,,Cf,.rt.~~-~ / ~nJ ~vf <br /> 13. PROPOSED PROJECT 14. CONGRESSIONAL DI TS OF: <br /> Start Date Ending Date a. Applicant b. Project <br /> I - 03 r2-3D -fl Fo ~ a.~.<-E'l.. <br /> 15. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE <br /> ORDER 12372 PROCESS? <br /> a. Federal $ .00 <br /> / ~ OCR O a. YES. THIS PREAPPLICATION/APPLICATION WAS MADE <br /> b. Applicant $ 00 AVAILABLE TO THE STATE F~CECUTNE ORDER 12372 <br /> S30 PROCESS FOR REVIEW ON: <br /> o. State $ .0° <br /> DATE <br /> d. Local $ .0° <br /> b. No. ~ t'ROGRAM IS NOT COVERED BY E. 0.12372 <br /> e. Other $ .0° ? OR PROGRAM HAS NOT BEEN SELECTED BY STATE <br /> FOR REVIEW <br /> f. Program Income $ .00 <br /> 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br /> g. TOTAL $ .00 <br /> a ~I OOD ? Yes If "Yes," attach an explanation. [t~'~Jo <br /> 18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/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 AuthoAriz~ed Representative b. Title c. Tel phon Number <br /> d. nat re of A{/thorized t3e~srue e. j'~ ~ 3 <br /> <br /> ~-v ` tJ <br /> rev' Edition Usable S andard Form 424 (Rev. 7-97) <br /> thorized for Local Reproduction Prescribed by OMB Circular A-102 <br /> <br />