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APPLICATION FOR oMB Approval No. o3as-oo43 <br /> FEDERAL ASSISTANCE 2. DATE SUBMITTED Appticantldenfifier <br /> ~-I-o3 <br /> 1. TYPE OF SUBMISSION: 3. DATE RECEIVED BY STATE State Application Identifier <br /> li fion Preappfication <br /> Construction ? Construction 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier <br /> Non-Constnu6on Non-Construction <br /> 5. APPLICANT INFORMATION <br /> Legal Name: Organizational Unit: <br /> G; .aim ~ ,~-bt;c t,c1o~~S ~ a~f- <br /> Address (g a pty. county, Sfafe, a Zip: code): Name and telephone number of person to be contacted on matters invohrin <br /> QS ~ P~~( this appC~cation(give:area.ogde) xw!-F' L'Oty/ <br /> 0 5'~c bga- S~Y~ <br /> 6. EMPLOY IDE TIFlCATION NUMBER (EIAI): 7. TYPE OF APPLICANT: (ent~rappmpriate ktterfn box) <br /> - ©O O ~ ~ 6 O A. State H. Independent School Gist. <br /> 8. TYPE OF APPLICATION: B. County State Controlled Instfiution of Higher Leamuig <br /> ~ew Q Continuation ?Revision C. Municipal J. Private Universfiy <br /> D. Township K Irxfian Tn'be <br /> ff Revision, enter appropriate letter(s) in box(es) ~ ~ E. Interstate L. Individual <br /> F. Intermunicipal M. Profd Organization <br /> A. increase Award B. Decrease Award C. tnrxease Duratiron G. Special District N. Other (Speafy) <br /> D. Decrease Duration Other(speci/y): <br /> 9. NAME OF FEDERAL AGENCY: <br /> Gt.S. /~i~.crbu- L•vyef Mar <br /> 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: <br /> ~ ~ X 1~ra~e.,~F~Y ~-~d ~a Stfaf <br /> TITLE: lc~/ t Is-f-l. Mafia. _ " G <br /> 12. AREAS AFFECTED BY PROJECT(~Ses, Cvtttifie~::Stafifs;~ta): ~n~ q,~CGrvt~La.~ ~jv~ ~Vf <br /> La.~?t- ~0~...-~-f d t <br /> 13. PROPOSED PROJECT 14. CONGRESSIONAL DI TS OF: <br /> Start Date Ending Date a. Applicant b, Project <br /> 03 ~~-3D - o Fo a.,~.l-S-l.~. <br /> 15. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE <br /> ORDER 12372 PROCESS? <br /> a. Federal $ .00 <br /> ! O ~D O a. YES. THIS t?REAPPLICATIOWAPPUCATION WAS MADE <br /> b. Applicant $ .00 AVAILABLE TO THE STATE IXECUTNE ORDER 12372 <br /> 53o aD PROCESS FOR REVIEW ON: <br /> c. State $ °D <br /> GATE <br /> d. Local $ °D <br /> b. No. ~ROGRAM IS NOT COVERED BY E. 0.12372 <br /> e. Other $ .00 ? OR PROGRAM HAS NOT BEEN SELECTED BY STATE <br /> FOR REVIEW <br /> f. Program Income $ 00 <br /> 1T. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br /> g. TOTAL $ --7w 00 . <br /> a TVt OvD ? Yes tf "Yes," attach an explanation. [~Io <br /> 18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPUCATION ARE TRUE AND CORRECT, THE <br /> DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITN THE <br /> ATTACHED ASSURANCES 1F THE ASSISTANCE iS AWARDED. <br /> a. Type Name of Authorized Representative b. Title c. Tel phon Number <br /> ~nn~s M • lA( C; Mct.• a Syl 1- 5 3 3 <br /> ~ d. nat re of Authorized 1~ePresentat'we. e, i <br /> <br /> ~ ~ ~ 3 <br /> rev' Edition Usable S ndard Form 424 {Rev. 7-97) <br /> thorized for Local Reproduction Prescribed by OMB Circular A-102 <br /> <br />