FY27 SAFE Senior SAFE Grant Application Form.xlsx

Cover Sheet

**Download and save the application before completing it in Microsoft Excel** FY27 STUDENT AWARENESS OF FIRE EDUCATION (SAFE) & SENIOR SAFE GRANT APPLICATION 1. Department Information: Select municipality/fire department from drop-down menu, then enter the department's address information.

2. Eligiblity: If reporting status displays as "Non-Compliant" please reach out to DFS.

3. Application Type: Select an option in all three applicaiton type drop-down menus. All three fields must be completed for the application to function properly.

4. Contact Information: Provide complete contact information for all required program contacts, including fire department, school and senior agency officials.

5. Next Step: Once this page is complete:

* Single Department Application: Proceed to the 'School Selections' tab. ** Joint/Regional Application: Proceed to the 'Joint Applicants' tab.

Note: To change information in a cell, click cursor in the cell and press delete, then enter the correct information.

Additional instructions and program requirements can be found in the FY27 Notice of Funding Opportunity (NOFO) document.

Legal Name of Applicant Agency:

Street Address: PO Box:

Municipality: Zip Code:

Eligibility Requirements

MFIRS/NERIS Reporting Status:

Applicants must be compliant with MFIRS/NERIS reporting requirements for calendar year 2025 by the application deadline to be eligible for funding.

Application Type

SAFE Application Type: Senior SAFE Application Type Select whether your application is for a single department or multiple departments here:

Select application type from each of the drop down selections.

First Name: Title:

Middle Initial: Phone Number:

Last Name: Email Address:

Has this individual completed PFALSE Training?

Is this individual a licensed teacher?

Primary SAFE Educator

First Name: Title:

Middle Initial: Phone Number:

Last Name: Email Address:

Has this individual completed PFALSE Training?

Is this individual a licensed teacher?

Secondary SAFE Educator

First Name: Title:

Middle Initial: Phone Number:

Last Name: Email Address:

Has this individual completed PFALSE Training?

Grant Manager

First Name: Title:

Middle Initial: Phone Number:

Last Name: Email Address:

Leave this section blank if Fire Chief will be serving as Grant Manager

Superintendent

School District Name:

First Name: Title:

Middle Initial: Phone Number:

Last Name: Email Address:

Senior Agency Contact

Senior Agency Name:

First Name: Title:

Middle Initial: Phone Number:

Last Name: Email Address:

Joint Applicants

2. Supporting Application Reporting Requirements: Review the reporting status for all supporting applicants. If reporting status displays as "Non-Compliant" please reach out to DFS.

3. Contact Information and Signatures: Provide ALL required contact information and obtain all required signatures.

Supporting Applicant MFIRS/NERIS Reporting

SUPPORTING APPLICANT #1 SUPPORTING APPLICANT #2

Applicant Name: Applicant Name: N/A -

Fire Chief Name: Fire Chief Name: N/A -

Signature: Date: Signature: Date: N/A -

School Official Name: School Official Name: N/A -

Title: Title:

Signature: Date: Signature: Date:

Senior Agency Official Name: Senior Agency Official Name:

Title: Title:

Signature: Date: Signature: Date:

SUPPORTING APPLICANT #3 SUPPORTING APPLICANT #4

Applicant Name: Applicant Name:

Fire Chief Name: Fire Chief Name:

Signature: Date: Signature: Date:

School Official Name: School Official Name:

Title: Title:

Signature: Date: Signature: Date:

Senior Agency Official Name: Senior Agency Official Name:

Title: Title:

Signature: Date: Signature: Date:

School Selections

District #3: District #4:

SAFE-Senior SAFE Prog. Summary

FY27 SAFE & SENIOR SAFE GRANT APPLICATION

SAFE & Senior SAFE Program Summary

Residential Visits

How many residential safety visits does the department plan to conduct in FY27?

School Enrollment Data