ANNEX 4 - PHASE 2 BUSINESS APPLICATION COVER PAGE for FY20 RFA (FINAL 12.4.2019).pdf

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American Schools and Hospitals Abroad Program Worldwide
Opportunity number
72ASHA20RFA00001
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Annex 4a

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ANNEX 2 - PHASE 2 TEMPLATE for FY20 RFA(FINAL 12.4.2019).docx DOCX document
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ANNEX 4 – PHASE 2 BUSINESS COST APPLICATION COVER PAGE

I. Cover Page

1. Date of submission:

2. Solicitation number of this RFA:

3. Name of the applicant USO and address:

4. USO’s Dun and Bradstreet Universal Numbering System (DUNS) number: _____________________

5. The USO’s System for Award Management (SAM) expiration date:_________________

6. USO’s Federal Employer Identification Number (EIN): _______________________

7. Name of the benefiting OSI and address:

Check one: School/university Hospital Center Library Center of Excellence

8. Amount of federal funding requested: ______________

9. Amount of leveraged funds (if applicable): _____________ or cost share (if applicable): __________

10. The total activity cost: ___________________

11. Activity Name/Title: ______________________________________________

12. ASHA Funding Is For:

Commodities-only

13. Project Summary:

Construction/renovation with commodities / without commodities

Please describe what the ASHA resources will fund:

ANNEX 1 – PHASE 1 TECHNICAL APPLICATION TEMPLATE
Untitled
Untitled
Blank Page
3 Name of the applicant USO and address 2:
4 USOs Dun and Bradstreet Universal Numbering System DUNS number:
5 The USOs System for Award Management SAM expiration date:
6 USOs Federal Employer Identification Number EIN:
7 Name of the benefiting OSI and address:
MM / DD / YYYY:
RFA NUMBER:
Name of USO:
7:
Address of benefitting OSI:
Check Box6: Off
Check Box8: Off
Check Box9: Off
Check Box10: Off
Check Box11: Off
8 Amount of lfederal funding requested:
9:
Leveraged funds:
cost share if applicable:
10:
The total activity cost:
11:
Activity Name/Title:
without: Off
with: Off
Description of what's ASHA funded:
Project summary:

Group12: Off

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