Key Contact Form_Feb 2020.pdf
PDF 43 KB Posted
- Attached to
- U.S. EMBASSY MANAGUA - ANNUAL PROGRAM STATEMENT
- Opportunity number
- PAS-MANAGUA-FY21-01
- Issued by
-
Department of State US Embassy Managua
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Key contact form
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Key_Contacts mhughes D:20061102110942- 05'00' D:20061102111030- 05'00' OMB Number: 4040-0010 Expiration Date: 12/31/2022
* Applicant Organization Name:
Key Contacts Form Prefix:
* First Name:
Middle Name:
* Last Name:
Suffix:
Title:
Organizational Affiliation:
* Street1:
Street2:
* City:
County:
* State:
Province:
* Country:
* Zip / Postal Code:
* Telephone Number:
Fax:
* Email:
Enter the individual's role on the project (e.g., project manager, fiscal contact).
Enter the individual's role on the project (for example, project manager, fiscal contact).
| Mandatory: |
| XDPFirstField: |
| CloseForm: |
| GotoPreviousPage: |
| GotoNextPage: |
| PrintButton: |
| AboutButton: |
| btnExport: |
| Organization Name: Enter the legal name of the applicant that will undertake the assistance activity. This field is required.: |
| DataEntered_2: |
| Contact Project Role: Enter the project role of the contact person (e.g., project manager, fiscal contact). |
Additional contacts are optional.:
Prefix: Select the Prefix from the provided list or enter a new Prefix not provided on the list.:
| First Name: Enter the First Name. This field is required.: |
| Middle Name: Enter the Middle Name.: |
| Last Name: Enter the Last Name. This field is required.: |
| Suffix: Select the Suffix from the provided list or |
enter a new Suffix not provided on the list.:
| Title: Enter the position title.: |
| Organization Affiliation: Enter the Organizational Affiliation of |
the person to contact on matters related to this application.:
| Street1: Enter the first line of the Street Address. This field is required.: |
| Street2: Enter the second line of the Street Address.: |
| City: Enter the City. This field is required.: |
| County: Enter the County.: |
| Country: Select the Country from the provided list. |
This field is required.:
| Province: Enter the Province.: |
| State: Select the state, US possession or military code from the provided list. |
This field is required if Country is the United States.:
Zip / Postal Code: Enter the Postal Code (e.g., ZIP code).
This field is required if Country is the United States.:
| Phone Number: Enter the daytime Telephone Number. This field is required.: |
| Fax: Enter the Fax Number.: |
| Email: Enter a valid Email Address. This field is required.: |
| recordno: |
| DeleteEntry: |
| PrevPage: |
| NextPage: |
| isBlank: |
| LastField: |
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