Applicant POC Form.pdf

Instructions for Completing Applicant Contact(s) Information

To be completed by the applicant.

Click to jump to fillable form.

1. Enter the applicant organization name. For an individual applicant, enter the first and last name.

2. Enter a brief title describing the project or work that will be covered by the agreement. This information helps agency staff identify the agreement to track processing before an agreement number is assigned.

3. Enter the 12-digit Alpha-Numeric Unique Entity Identifier (UEI) assigned by SAM.gov. If you are an individual without an active SAM registration, leave this box blank.

Complete all boxes 4-7.

Enter the name, phone, title, and email for each contact in accordance with the descriptions below.

One individual may fill multiple roles, however to ensure adequate internal controls, a minimum of two different people must be identified.

4. Administrative Contact:

The individual responsible for administrative functions to manage the agreement. This individual is typically the main point of contact for the agreement and will receive auto-generated emails from the grants management system regarding actionable items. This individual is typically responsible for the content of the financial reporting for the project.

5. Program Contact:

This individual typically provides direct supervision and day-to-day oversight of the project. This individual will receive auto-generated emails from the grants management system regarding actionable items. This individual is typically responsible for the content of the performance reporting for the project.

6. Program Director:

This individual is responsible for overall responsibility for the project but may or may not be personally involved with the day-to-day oversight of the project.

7. Signatory Official:

The individual with legal authority to commit the organization to financial and other responsibilities.

8. This section must list key personnel by name, title, role, and responsibilities, including specific tasks and subtasks designated to them in the project proposal. If none, enter "NONE" below. Key personnel have the primary responsibility for the leadership of the project and actively participate in the development, delivery, and management of the project. Key personnel may include the Program Contact, Program Director, and staff whose contributions are essential to the success of the project.

Changes in key personnel will require prior approval. Direct questions about key personnel to your agency contact.

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Applicant Contact(s) Information, to be completed by the applicant.

Phone

Email

Phone

Email

Phone

Email

Phone

Email

1. Applicant Organization Name

2. Unique Official Project Title For project tracking prior to assignment of identifying number and limited to 40 characters

This section must list key personnel by name, title, role, and responsibilities, including specific tasks and subtasks designated to them in the project proposal. If none, enter "NONE" below.

Changes in key personnel will require prior approval. Direct questions about key personnel to your agency contact.

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3. Applicant Unique Entity Identifier (UEI)

Individuals who will be designated as person(s) responsible on behalf of the applicant's organization.

See instructions for description for these roles.

Complete boxes 4 - 7. To ensure adequate internal controls, a minimum of two different people must be identified.

4. Administrative Contact Name

Title

5. Program Contact Name

Title

6. Program Director Name

Title

7. Signatory Official Name

Title

8. Key Personnel: