Appendix K Partnership.pdf

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Submission sphelps D:20061219143208- 05'00' D:20061219143305- 05'00'

* Application Filing Name:

Grant Application Package Grants.gov Grant Application Package CFDA Number:

Opportunity Title:

Offering Agency:

Agency Contact:

Opportunity Open Date:

Opportunity Close Date:

Mandatory Documents Move Form to Complete Move Form to Delete Mandatory Documents for Submission Optional Documents Move Form to Submission List Move Form to Delete Optional Documents for Submission Instructions CFDA Description:

Opportunity Number:

Competition ID:

This electronic grants application is intended to be used to apply for the specific Federal funding opportunity referenced here.

If the Federal funding opportunity listed is not the opportunity for which you want to apply, close this application package by clicking on the "Cancel" button at the top of this screen. You will then need to locate the correct Federal funding opportunity, download its application and then apply.

Grants.gov Name- Version Form Tag Name Name- Version Form Tag Name Name- Version Form Tag Name Name- Version Form Tag Name Enter a name for the application in the Application Filing Name field.

- This application can be completed in its entirety offline; however, you will need to login to the Grants.gov website during the submission process.

- You can save your application at any time by clicking the "Save" button at the top of your screen.

- The "Save & Submit" button will not be functional until all required data fields in the application are completed and you clicked on the "Check Package for Errors" button and confirmed all data required data fields are completed.

1. Enter a name for the application in the Application Filing Name field. - This application can be completed in its entirety offline; however, you will need to login to the Grants.gov website during the submission process. - You can save your application at any time by clicking the "Save" button at the top of your screen. - The "Save & Submit" button will not be functional until all required data fields in the application are completed and you clicked on the "Check Package for Errors" button and confirmed all data required data fields are completed.

Open and complete all of the documents listed in the "Mandatory Documents" box. Complete the SF-424 form first.

- It is recommended that the SF-424 form be the first form completed for the application package. Data entered on the SF-424 will populate data fields in other mandatory and optional forms and the user cannot enter data in these fields.

- The forms listed in the "Mandatory Documents" box and "Optional Documents" may be predefined forms, such as SF-424, forms where a document needs to be attached, such as the Project Narrative or a combination of both. "Mandatory Documents" are required for this application. "Optional Documents" can be used to provide additional support for this application or may be required for specific types of grant activity. Reference the application package instructions for more information regarding "Optional Documents".

- To open and complete a form, simply click on the form's name to select the item and then click on the => button. This will move the document to the appropriate "Documents for Submission" box and the form will be automatically added to your application package. To view the form, scroll down the screen or select the form name and click on the "Open Form" button to begin completing the required data fields. To remove a form/document from the "Documents for Submission" box, click the document name to select it, and then click the <= button. This will return the form/document to the "Mandatory Documents" or "Optional Documents" box.

- All documents listed in the "Mandatory Documents" box must be moved to the "Mandatory Documents for Submission" box. When you open a required form, the fields which must be completed are highlighted in yellow with a red border. Optional fields and completed fields are displayed in white. If you enter invalid or incomplete information in a field, you will receive an error message.

2. Open and complete all of the documents listed in the "Mandatory Documents" box. Complete the SF-424 form first. - It is recommended that the SF-424 form be the first form completed for the application package. Data entered on the SF-424 will populate data fields in other mandatory and optional forms and the user cannot enter data in these fields. - The forms listed in the "Mandatory Documents" box and "Optional Documents" may be predefined forms, such as SF-424, forms where a document needs to be attached, such as the Project Narrative or a combination of both. "Mandatory Documents" are required for this application. "Optional Documents" can be used to provide additional support for this application or may be required for specific types of grant activity. Reference the application package instructions for more information regarding "Optional Documents". - To open and complete a form, simply click on the form's name to select the item and then click on the => button. This will move the document to the appropriate "Documents for Submission" box and the form will be automatically added to your application package. To view the form, scroll down the screen or select the form name and click on the "Open Form" button to begin completing the required data fields. To remove a form/document from the "Documents for Submission" box, click the document name to select it, and then click the <= button. This will return the form/document to the "Mandatory Documents" or "Optional Documents" box. - All documents listed in the "Mandatory Documents" box must be moved to the "Mandatory Documents for Submission" box. When you open a required form, the fields which must be completed are highlighted in yellow with a red border. Optional fields and completed fields are displayed in white. If you enter invalid or incomplete information in a field, you will receive an error message.

Click the "Save & Submit" button to submit your application to Grants.gov.

- Once you have properly completed all required documents and attached any required or optional documentation, save the completed application by clicking on the "Save" button.

- Click on the "Check Package for Errors" button to ensure that you have completed all required data fields. Correct any errors or if none are found, save the application package.

- The "Save & Submit" button will become active; click on the "Save & Submit" button to begin the application submission process.

- You will be taken to the applicant login page to enter your Grants.gov username and password. Follow all onscreen instructions for submission.

3. Click the "Save & Submit" button to submit your application to Grants.gov. - Once you have properly completed all required documents and attached any required or optional documentation, save the completed application by clicking on the "Save" button. - Click on the "Check Package for Errors" button to ensure that you have completed all required data fields. Correct any errors or if none are found, save the application package. - The "Save & Submit" button will become active; click on the "Save & Submit" button to begin the application submission process. - You will be taken to the applicant login page to enter your Grants.gov username and password. Follow all onscreen instructions for submission.

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Email: support@grants.gov Phone: 1-800-518-4726

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Install the required version and try again.

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Email: support@grants.gov Phone: 1-800-518-4726

APPLICATION FOR FEDERAL ASSISTANCE SF-424 - MANDATORY

OMB Number: 4040-0002 Expiration Date: 08/31/2008

* 1.a. Type of Submission:

* Other (specify)

* 1.b. Frequency:

Version 01.1

* Other (specify) 1.c. Consolidated Application/Plan/Funding Request?

* 1.d. Version:

* 2. Date Received:

3. Applicant Identifier:

4a. Federal Entity Identifier:

4b. Federal Award Identifier:

5. Date Received by State:

6. State Application Identifier:

* c. Organizational DUNS:

Department Name:

Division Name:

* Street1:

Street2:

* City:

County:

* State:

Province:

* Zip / Postal Code:

* Country:

* b. Employer/Taxpayer Identification Number (EIN/TIN):

Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

Title:

Organizational Affiliation:

* Telephone Number:

Fax Number:

* Email:

STATE USE ONLY:

7. APPLICANT INFORMATION:

d. Address:

* a. Legal Name:

e. Organizational Unit:

f. Name and contact information of person to be contacted on matters involving this submission:

Authorized for Local Reproduction Standard Form 424 Mandatory (Effective 08/2005) Prescribed by OMB Circular A-102 Type of Submission: Select one type of submission in accordance with agency instructions. This field is required.

Type of Submission is required: Select one type of submission in accordance with agency instructions.

Frequency: Select the applicable frequency for the type of submission. This field is required.

Frequency is required: Select the applicable frequency for the type of submission.

Consolidated Application/Plan/Funding Request: Indicate if the submission is a consolidated application/plan/funding request.

Version: Select the applicable version for the type of submission. This field is required.

Version is required: Select the applicable version for the type of submission.

* 8a. TYPE OF APPLICANT:

* Other (specify):

b. Additional Description:

* 9. Name of Federal Agency:

10. Catalog of Federal Domestic Assistance Number:

CFDA Title:

11. Areas Affected by Funding:

* a. Applicant:

b. Program/Project:

a. Start Date:

b. End Date:

* a. Federal ($):

b. Match ($):

* 15. IS SUBMISSION SUBJECT TO REVIEW BY STATE UNDER EXECUTIVE ORDER 12372 PROCESS?

Is Submission Subject to Review: Applicants should contact the State Single Point of Contact (SPOC) for Federal Executive Order 12372 to determine whether the application is subject to the State intergovernmental review process. This field is required.

12. CONGRESSIONAL DISTRICTS OF:

13. FUNDING PERIOD:

14. ESTIMATED FUNDING:

APPLICATION FOR FEDERAL ASSISTANCE SF-424 - MANDATORY

OMB Number: 4040-0002 Expiration Date: 08/31/2008 Version 01.1 Attach an additional list of Program/Project Congressional Districts if needed.

Authorized for Local Reproduction Standard Form 424 Mandatory (Effective 08/2005) Prescribed by OMB Circular A-102 Is Submission Subject to Review is required: Applicants should contact the State Single Point of Contact (SPOC) for Federal Executive Order 12372 to determine whether the application is subject to the State intergovernmental review process.

* 16. Is The Applicant Delinquent On Any Federal Debt?

** I Agree Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

* Title:

Organizational Affiliation:

* Telephone Number:

* Email:

* Fax Number:

* Signature of Authorized Representative:

* Date Signed:

17. By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001) Authorized Representative:

Attach supporting documents as specified in agency instructions.

APPLICATION FOR FEDERAL ASSISTANCE SF-424 - MANDATORY

OMB Number: 4040-0002 Expiration Date: 08/31/2008 Version 01.1 ** This list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions.

Authorized for Local Reproduction Standard Form 424 Mandatory (Effective 08/2005) Prescribed by OMB Circular A-102 Is The Applicant Delinquent On Any Federal Debt: This question applies to the applicant organization, not the person who signs as the authorized representative. This field is required.

Is The Applicant Delinquent On Any Federal Debt is required: This question applies to the applicant organization, not the person who signs as the authorized representative.

Form Attachments:

Authorized for Local Reproduction Standard Form 424 Mandatory (Effective 08/2005) Prescribed by OMB Circular A-102

APPLICATION FOR FEDERAL ASSISTANCE SF-424 - MANDATORY

* Consolidate Application/Plan/Funding Request Explantion Authorized for Local Reproduction Standard Form 424 Mandatory (Effective 08/2005) Prescribed by OMB Circular A-102

APPLICATION FOR FEDERAL ASSISTANCE SF-424 - MANDATORY

* Applicant Federal Debt Delinquent Explanation

APPLICATION FOR FEDERAL ASSISTANCE SF-424 - MANDATORY

ATTACHMENTS FORM

Instructions: On this form, you will attach the various files that make up your grant application. Please consult with the appropriate Agency Guidelines for more information about each needed file. Please remember that any files you attach must be in the document format and named as specified in the Guidelines.

Instructions: On this form, you will attach the various files that make up your grant application. Please consult with the appropriate Agency Guidelines for more information about each needed file. Please remember that any files you attach must be in the document format and named as specified in the Guidelines.

Important: Please attach your files in the proper sequence. See the appropriate Agency Guidelines for details.

Important: Please attach your files in the proper sequence. See the appropriate Agency Guidelines for details.

15) Please attach Attachment 15

1) Please attach Attachment 1

2) Please attach Attachment 2

3) Please attach Attachment 3

4) Please attach Attachment 4

5) Please attach Attachment 5

6) Please attach Attachment 6

7) Please attach Attachment 7

8) Please attach Attachment 8

9) Please attach Attachment 9

10) Please attach Attachment 10

11) Please attach Attachment 11

12) Please attach Attachment 12

13) Please attach Attachment 13

14) Please attach Attachment 14 Enter the Zip Code (or ZIP+4) of the Lobbying Registrant City of the Lobbying Registrant.

Enter the second line of street address for the Lobbying Registrant Enter the first line of street address for the Lobbying Registrant.

Enter the Zip Code (or ZIP+4) of the Lobbying Registrant City of the Lobbying Registrant.

Enter the second line of street address for the Lobbying Registrant Enter the first line of street address for the Lobbying Registrant.

10. a. Name and Address of Lobbying Registrant:

9. Award Amount, if known:$

* Street 1

* City State Zip Street 2

* Last Name Prefix

* First Name Middle Name Suffix

DISCLOSURE OF LOBBYING ACTIVITIES

Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352 Approved by OMB 0348-0046

1. * Type of Federal Action:

2. * Status of Federal Action:

3. * Report Type:

For Material Change Only:

year quarter date of last report

4. Name and Address of Reporting Entity:

Tier if known:

* Name

* Street 1 Street 2

* City State Zip Congressional District, if known:

Congressional District, if known:

* Name

* City State

* Street 1 Street 2 Zip

6. * Federal Department/Agency:

7. * Federal Program Name/Description:

CFDA Number, if applicable:

8. Federal Action Number, if known:

b. Individual Performing Services (including address if different from No. 10a) Prefix

* First Name Middle Name

* Street 1

* City State Zip Street 2 11.

* Last Name Suffix Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

* Signature:

*Name:

Prefix

* First Name Middle Name

* Last Name Suffix Title:

Telephone No.:

Date:

Federal Use Only:

Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97) County:

* ZIP / Postal Code:

* Country:

* State:

* City:

Street2:

Organization Name:

Project/Performance Site Location(s) Project/Performance Site Primary Location

* Street1:

Province:

OMB Number: 4040-0010 Expiration Date: 08/31/2011 I am submitting an application as an individual, and not on behalf of a company, state, local or tribal government, academia, or other type of organization.

DUNS Number:

* Project/ Performance Site Congressional District:

Project/Performance Site Location

* ZIP / Postal Code:

* Country:

Province:

* State:

* City:

Street2:

* Street1:

Organization Name:

County:

DUNS Number:

* Project/ Performance Site Congressional District:

I am submitting an application as an individual, and not on behalf of a company, state, local or tribal government, academia, or other type of organization.

Project/Performance Site Location(s) PerformanceSite_1_2 SF424 Mandatory Form Attachments Disclosure of Lobbying Activities (SF-LLL) Project/Performance Site Location(s) SF424_Mandatory Attachments

SFLLL

PerformanceSite_1_2 This opportunity is only open to organizations, applicants who are submitting grant applications on behalf of a company, state, local or tribal government, academia, or other type of organization.

This opportunity is only open to organizations, applicants who are submitting grant applications on behalf of a company, state, local or tribal government, academia, or other type of organization.

9.1 Application Annual N: No Initial Grant InitialAward InitialFiling Y: Yes

service, laboratory, or equivalent level within the organization which will undertake the assistance activity.:

Number. Examples: CA-005 for California's 5th district, CA-012 for California's 12th district.

If outside the US, enter 00-000.

This field is required.:

Project: Enter the Congressional District in the format: 2 character State Abbreviation - 3 character District Number. Examples: CA-005 for California's 5th district, CA-012 for California's 12th district.

If all districts in a state are affected, enter "all" for the district number. Example: MD-all for all congressional districts in Maryland.

If nationwide (all districts in all states), enter US-all.

If the program/project is outside the US, enter 00-000.:

Enter in the format mm/dd/yyyy.:

Start Date: Enter the start date of the funding period for this submission.

Enter in the format mm/dd/yyyy.:

the programs covered by the consolidated submission as required in agency instructions. :

the report as the SubAwardee Federal recipient. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.:

enter the address of the prime Federal recipient.:

If the organization filing the report in item 4, checks "Subawardee", enter the Congressional District of the prime Federal recipient, if known. Should be numeric characters.:

If the organization filing the report in item 4, checks "Subawardee", select the appropriate state from this pull down menu.:

If the organization filing the report in item 4, checks "Subawardee, enter the full name of the prime Federal recipient.:

Street1: If the organization filing the report in item 4, checks "Subawardee", enter the address of the prime Federal recipient.:

If the organization filing the report in item 4, checks "Subawardee", enter the city of the prime Federal recipient.:

If the organization filing the report in item 4, checks "Subawardee", enter the zip code.:

Enter the name of the Federal Department or Agency making the award or loan commitment. :

Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments.:

Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments.:

Enter the most appropriate Federal identifying number available for the Federal action, identified in item 1 (e.g., Request for Proposal (RFP) number, invitation for Bid (IFB) number, grant announcement number, the contract, grant, or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001".:

For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment of the prime entity identified in item 4 or 5.:

as an individual and not on behalf of or representing any organization.: N: No Individual: Select if submitting application as an individual and not on behalf of or representing any organization.: N: No ORGANIZATION NAME (Project Performance Site): Indicate the organization name of the primary site where the work will be performed. If a portion of the project will be performed at any other sites(s), identify the site location(s) in the block(s) provided. (This field is not applicable for applicants using SF 424 Individual Form Set.):

DUNS Number: Enter the DUNS number associated with the organization where the project will be performed. (Note this field is not required for applicants using the SF 424 Individual Form Set).:

Street1 (Project Performance Site): Enter first line of the street address in "Street 1" field of the primary performance site location. This field is required.:

Street2 (Project Performance Site): Enter second line of the street address in "Street 2" field for the primary performance site location. This field is optional.:

City (Project Performance Site): Enter the City for address of the primary performance site location. This field is required.:

County (Project Performance Site): Enter the County of the performance site location.:

State (Project Performance Site): Enter the State where the primary performance site location is located. This field is required if the Project Performance Site is located in the United States.:

Province (Project Performance Site):

Enter the Province where the primary performance site location is located. :

Country (Project Performance Site):

Select the country for the primary performance site location.:

Zip / Postal Code (Project Performance Site): Enter the nine-digit Postal Code (e.g., ZIP code) of the primary performance site location. This field is required if the Project Performance Site is located in the United States.:

Program District: Enter the Congressional District in the format: 2 character State Abbreviation - 3 character District Number. Examples: CA-005 for California's 5th district, CA-012 for California's 12th district.

If all districts in a state are affected, enter "all" for the district number.

Example: MD-all for all congressional districts in Maryland.

If nationwide (all districts in all states), enter US-all.

If the program/project is outside the US, enter 00-000.

To locate your congressional district, visit the Grants.gov web site. Note it is likely that this field will be identical to the “Congressional Districts of Applicant” field provided elsewhere in this application. :

associated with the organization where the project will be performed. (Note this field is not required for applicants using the SF 424 Individual Form Set).:

Individual: Select if submitting application as an individual and not on behalf of or representing any organization.:

ORGANIZATION NAME (Project Performance Site): Indicate the organization name of the primary site where the work will be performed. If a portion of the project will be performed at any other sites(s), identify the site location(s) in the block(s) provided. (This field is not applicable for applicants using SF 424 Individual Form Set.):

Street1 (Project Performance Site): Enter first line of the street address in "Street 1" field of the primary performance site location. This field is required.:

Street2 (Project Performance Site): Enter second line of the street address in "Street 2" field for the primary performance site location. This field is optional.:

City (Project Performance Site): Enter the City for address of the primary performance site location. This field is required.:

County (Project Performance Site): Enter the County of the performance site location.:

State (Project Performance Site): Enter the State where the primary performance site location is located. This field is required if the Project Performance Site is located in the United States.:

Province (Project Performance Site):

Enter the Province where the primary performance site location is located. :

Country (Project Performance Site):

Select the name of the country for the primary project performance site.:

Zip / Postal Code (Project Performance Site): Enter the nine-digit Postal Code (e.g., ZIP code) of the primary performance site location. This field is required if the Project Performance Site is located in the United States.:

Program District: Enter the Congressional District in the format: 2 character State Abbreviation - 3 character District Number. Examples: CA-005 for California's 5th district, CA-012 for California's 12th district.

If all districts in a state are affected, enter "all" for the district number.

Example: MD-all for all congressional districts in Maryland.

If nationwide (all districts in all states), enter US-all.

If the program/project is outside the US, enter 00-000.

To locate your congressional district, visit the Grants.gov web site. Note it is likely that this field will be identical to the “Congressional Districts of Applicant” field provided elsewhere in this application.: