The file's text, extracted by GovTribe without its formatting.
Instructions for Application for Federal Domestic Assistance - Individual
| Item |
| Field Name |
| Information |
| 1. |
| NAME OF FEDERAL AGENCY |
| Pre-populated from the Application cover sheet. |
| 2. |
| CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: |
| Pre-populated from the Application cover sheet. |
| CFDA TITLE: |
| Pre-populated from the Application cover sheet. |
| 3. |
| DATE RECEIVED |
| Completed by Grants.gov upon submission. |
| 4. |
| FUNDING OPPORTUNITY NUMBER: |
| Pre-populated from the Application cover sheet. |
| TITLE: |
| Pre-populated from the Application cover sheet. |
a. Name and Contact Information
| 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. |
| Fax Number: |
| Enter the Fax Number. |
| Email: |
| Enter a valid Email Address. |
| Telephone Number (Daytime): |
| Enter the daytime Telephone Number. This field is required. |
| Telephone Number (Evening): |
| Enter the evening Telephone Number. |
b. Address
| 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 / Parish: |
| Enter the County or Parish. |
| State: |
| Select the state, US possession or military code from the provided list. This field is required if Country is the United States. |
| Province: |
| Enter the Province. |
| Country: |
| Select the Country from the provided list. This field is required. |
| Zip / Postal Code: |
| Enter the nine-digit Postal Code (e.g., ZIP code). This field is required if Country is the United States. |
c. Citizenship Status:
| U.S. Citizenship? Yes / No |
| Select Yes if applicant is a citizen of the United States. Select No if applicant is a permanent resident and enter the Alien Registration #. Select No if applicant is a foreign national and enter the country of citizenship and start date of most recent residency in the United States. |
If No
| If permanent resident of U.S., enter the Alien Registration # |
| Enter the Alien Registration Number. |
| If foreign national, enter country of citizenship: |
| Select the Country from the provided list. This field is required if the applicant is not a U.S. Citizen. |
| If foreign national, enter start date of most recent residency in U.S.: |
| Enter the start date of the most recent residency in the U.S. Enter in the format MM/DD/YYYY. This field is required if the applicant is not a U.S. Citizen. |
| d. Congressional District of Applicant: |
| 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, NC-103 for North Carolina's 103rd district. This field is required. If outside the US, enter 00-000. |
| a. Project Title |
| Enter a brief, descriptive title of the project. |
| b. Project Description |
| Enter a brief description of the project. This field is required. |
| c. Proposed Project |
| Start Date: Enter the start date for the proposed project. Enter in the format MM/DD/YYYY. This field is required. |
End Date: Enter the end date for the proposed project. Enter in the format MM/DD/YYYY. This field is required.
| 7. |
| * 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 fradulent statements or claims may subject me to criminal, civil, or administrative penalties (U.S. Code, Title 218, Section 1001)
** I AGREE
Check to select. This field is required.
** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions.
| Signature |
| Completed by Grants.gov upon submission. |
| Date Signed |
| Completed by Grants.gov upon submission. |
Department of State