ANNEX 2a - PHASE 2 COVER PAGE for FY22 RFA.pdf

American Schools and Hospitals Abroad Initiative Solicitation No.: 720DD122RFA00002

ANNEX 2a – PHASE 2 TECHNICAL APPLICATION COVER PAGE

I. Cover Page (3 pages)

1. Date of submission

2. Name of the applicant USO and address

3. USO’s Unique Entity Identifier (UEI): Please list the UEIs that apply to your organization.

System for Award Management UEI

Dun and Bradstreet Universal Numbering System (DUNS) number

4. The USO’s System for Award Management (SAM) expiration date

5. USO’s Federal Employer/Taxpayer Identification Number (EIN/TIN)

6. Name of the benefiting OSI and address

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

7. Amount of federal funding requested

8. Amount of leveraged funds (if applicable) or cost share (if applicable)

9. The total activity cost

10. Activity Name/Title

11. ASHA Funding Is For

Commodities only Construction/renovation only Construction/renovation with commodities

12. Please describe what the ASHA resources will fund:

13. Project Summary

14. Public Diplomacy Benefit Summary: Please provide a summary of the public diplomacy benefit of this project.

Optional: Applicants may also include a photo or sketch in the space below (does not count against the page limit):

SAM.GOV SCREENSHOT

Copy and paste a screenshot of the Applicant's current SAM account on this page.