Funding Application for CDBG Grant Funding

(* Denotes Required Fields)

Part I. Applicant
Program/Project Title: *
Organization/Applicant Name: *
Organization Representative/ Title: *
Address: *
Telephone number: *
Email: *
Organization DUNS Number:
Organization FEIN Number:
Organization CCR Number:
Contact Person/Title (if different):
Telephone number:
Cell phone:
PY47 Amount Requested: *
Part II. Project Description & Eligibility
A. Type of Entity 
A (Check one that describes the applicant): *
B. National Objective to be met is either a direct benefit to Low- and Moderate-Income Persons/Households or provides benefits to all persons in a Low- and Moderate-Income Area. Describe how beneficiary income will be determined, i.e. records maintained, census tracts, presumed benefit. 
National Objective Achieved by Project 
B (Check ONE National Objective): *
C. Consistency with the City’s Consolidated Plan 
C (Check ONE appropriate goal):
D. The program or project will meet the following Housing and Community Development Objective(s) or CDBG Annual Action Plan requirement(s) 
D (Check one or more that best describes the program or project): *
E. Type of Project 
E (Check line that best describes your project):
E Other (Please Describe):
F. Please provide a brief description of the program or project. Include the major activities and/or scope of services that will be conducted as part of the program/project. Also, please describe how the program/project will meet the Housing and Community Development Objective(s) or CDBG Annual Action Plan requirement(s) identified in Section D: 
F (Description):
G. Please explain what outcomes are expected to be achieved by the program or project. 
G (Description):
H. Will another entity besides the applicant be administering the project? If yes, please identify. 
H (Description):
I. Geographic Area to be Served (Please check one and enter details in the box below): *
I. Please enter the details for the previous selection in the space provided:
J. Population to be served or benefit (Please check all that apply) 
J. Estimated number of persons to be served by the project annually:
J. (Please check all that apply):
K. Income of population to be served or benefit 
K. (Please estimate numbers to be served):