Key_Contacts-V1.0.pdf

PDF 80 KB Posted

Attached to
Conservation Innovation Grants
Opportunity number
USDA-NRCS-NJ-CIG-19-GEN0010164
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Key Contacts

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Text version

OMB Number: 4040-0010 Expiration Date: 12/31/2019

* 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).

Key_Contacts mhughes D:20061102110942- 05'00' D:20061102111030- 05'00' OMB Number: 4040-0010 Expiration Date: 12/31/2019

* 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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