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<br />Type of Government Entity: <br />o State 0 City: 0 Town <br />o Village _0 Borough 0 Township <br />o Region 0 Council 0 Community <br />o Nation 0 School District <br />o Other (please specify): <br /> <br />o County <br />o Territory <br />o Pueblo <br /> <br />Contact Information: <br />Name of contact person in your department.who is familiar with this grant application: <br /> <br />Email: <br />Fax: <br /> <br />Title: <br />Telephone: <br /> <br />.. ~ . <br />nL Partnor Information <br /> <br />Under the COPS in Schools grant program, applicants rrius'{enter into a partnership agreement with an offici21 <br />for a specific school or school district with general educational oversight authority in that jurisdiction. If there <br />are going to be multiple partners involved in this project, please provide the following information for each of <br />the partners on a separate piece of paper. However, you must designate one school official as the school <br />representative under the grant program. Please provide the information for that individual in the space <br />below, If the proposed project affects an entire school district, then the official with general educational <br />oversight over the entire school district should complete the information below. <br /> <br />Name of Partner Agency or School District <br />School Official Name: <br />Address: <br />City: <br />State: <br />Phone: <br /> <br />Title: <br /> <br />Zip Code: <br />Fax: <br /> <br />In addition, at the time the application is submitted applicants for the COPS in Schools <br />grant program must include two written documents prepared in cooperation with the other <br />agency, or agencies, involved in the program, <br /> <br />First, a Memorandum of understanding (MOU) that details the roles and responsibilities of <br />the partners involved in this project. For additional information on the requirement, please <br />refer to page 7 of this Application Form. <br /> <br />Second. a COPS in Schools Narrative Addendum detailing the proposed project. For <br />additional information on the requirement. please refer to page 8 of this Application Form. <br /> <br />All COPS in Schools awards will contain an "Additional Grant Condition'. that must be signed and returned <br />to the COPS Office, This grant condition is contained in the award package. and requires the fundcd <br />omcer(s) and a school administratof to attend a COPS' in Schools Training, The ('OPS OOice ....ill reimburse <br />grantees for the training. pef diem. travel. and ludging fOf attendance of rr<{/IIml participants up tt' the <br />ma.ximum of S 1.1 00 per person attending. <br /> <br />II COPS In Schools <br /> <br />Application Funo <br /> <br />CJ <br />