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<br />1. For CJD Use Only 3, a. Date Submitted b. Applicant Identifier <br /> . <br />2, Fede<allSlate Program Cleulncatlon (For CJD Use Only)' 4, a, Date Received by State/COG b. State Application Identifier <br />5. Appncant Information <br />a, Legal Name: c, Organizational Unit <br />b. Address (five street or P. O. Box, cfty, state, and zip code) d. Name, telephone, and fax number of the person to be contacted <br /> concerning this appltcatlon (give area code), <br />.... .... . .. '..-,.,.... , c.' 7. Type of Applicant (entor the eppropriete /eUe' in boil 0 <br />'6;"'~State Payee Identification Number-' <br /> A. Slate H. Independent School District <br /> B, County I. Stat. Controlled Institution of HighM Learning <br /> C. Municipal J. Private UniYeraity <br />8. Type of Application: 0, Township K Indian Tribe <br /> E. Inter5late l. Individual <br /> a New a Continuation F, Intennunicipal M. Private Nonprol1t Co<poration <br /> G, Special Distric1 N. Other (specify): <br /> 9. Name of Grantor Agency: <br /> If continuation, enter year of funding Office of the Governor, Criminal Justice Divislon <br />10. If Application for Federal Funds: P. O. Box 12428 <br /> Austin, Te""s 78711 <br /> Chect.Catalog of Federal Domestic Assistance Number: (only one) 11. Geographic Areas of Project AclIviti.. {CIties end Counties} <br /> a 1 S.54O-Juvenile Justice & Delinquency Prevention Act <br /> a 18.57>-Victims of Crime Act <br />I a 16,579- Texas Narcotics Control Program <br />a 16,580-Hlgh Intensity Drug TraffICking Program <br />12. Trtle of Project: 13. Proposed Project: <br /> a. Start Date: b, Ending Date: <br />14. If Application for State Funds: <br />........................................................... ............................................:...............................................................................................................................................--............................ <br />a, Check appropriate fund; (onli on.) b. If 421 Fund, check priority: (only one) c. Check One: <br /> a 421 Fund CI C.J. Planning Q Law Enforcement Training CI Juvenile <br /> o Crime Stoppers Assistance Fund a VIOlent Crime a Drugs a Gangs a Victims a Non-juvenile <br /> a Other Fund <br />15, Requested Funding: 16, Is application subject to review by state executive order 12372 process? <br />a. Federal Grant $ ,00 <br /> Funds (CJD) a YES, this application was provided to the Texas Review and Comment System <br />.................................... ............................................................................ (TRACS) for review on <br />b. State Grant $ .00 <br /> Funds (CJD) (date) <br />c. Cash Match $ ,00 CI Program Is not covered by E. O. 12372 <br />.................................... .......--.......---.......-....................................... a Program has not been selected by s1aIe for review <br />d. In-Kind $ ,00 <br />(VOCA & Title V Only) 17, Is the applicant delinquent on any federal debt? . <br />.................................... ...................................-....................................... <br />e. TOTAL $ .00 <br /> a YES If "Yes" attach an explanation a NO <br />18. To the best of my knowledge and belief, all data in this application is true and correct. The document has been duly authorized by the governing <br /> body of the applicant and the applicant will comply with the attached assurances if the assistance is awarded. .- <br /> r <br />a. Typed Name of Authorized Official b, Tille c. Telephone Number <br />d, Signature of Authorized Official e. Date Signed <br /> <br />L1CA nON FOR STATE OR FEDERAL ASSi .NCE <br />OFFICE OF THE GOVERNOR, CRIMINAL JUSTICE DMSION <br /> <br />CID-l <br /> <br />Issued 10/94 <br />