Indicates required field Recipient Point of Contact First Name:Recipient Point of Contact Last Name:Phone Number: Email Address:Is the funding requested for a Government, Non-profit, or Other. Please explain if “Other”): In which municipality is the recipient located?Recipient Legal Name:Recipient Address:AddressAddress 2City/TownState/Province- Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingZIP/Postal CodeProject Address (If the Project Address is different than the Recipient Address, please fill out this field. If it is the same, please write “Same as Above”): AddressAddress 2City/TownState/Province- None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingZIP/Postal CodeProject DetailsProject Title: Project Description (Please attach Project Narrative or Project Description):Estimated Start Date:Estimated End Date:Request InformationProject Cost:Funds Requested from Federal Grant:Total Funds Raised to Date: Funds from Another Grant (Federal, State, or Local): Funds Raised Privately: Explain why it is a good use of taxpayer dollars: If you are requesting a Letter of Support, please provide the following information: Organization or Individual the Letter Should be Addressed to: If you are requesting a Letter of Support, please provide the following information: Organization or Individual the Letter Should be Addressed to (If you are not requesting a letter of support, please mark N/A where applicable):AddressAddress 2City/TownState/Province- Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingZIP/Postal CodeRecipient of Letter (to your organization or to the organization awarding the funds):Method of Delivery of the Letter: a.) Email:b.) Fax:c.) Mail (Keep blank if the address is the same as above):AddressAddress 2City/TownState/Province- None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingZIP/Postal CodeGrant Identifying or Receipt Number (If Available) : Deadline for Letter of Support: *If available, please attach a sample letter of support along with this form.One file only.2 MB limit.Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods. CAPTCHA: enabled to secure this form. If you are having difficulty using Captcha's visual option, please visit the Accessibility page for more assistance.