2003-172-RES AUTHORIZE WAIVER OF ELIGIBILITY TO APPLY FOR GRANT FROM JUVENILE ACCOUNTABILITY INCENTIVE BLOCK GRANT PROGRAM

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JUVENILE ACCOUNTABILITY BLOCK GRANT ( JAB G) WAIVER OF FUNDS FORM OFFICE OF THE GOYEIU'IOR CRIMINAL JUSTICE DIVISION P.O. Box 12428 AUSTIN, TEXAS 78711 512/463-1919 FAX: 5121475-2440 WWW.GOVERNOR.STATE.TX.US 1 l.A.C. ~3.1211 Any entity receiving a local allocation may waive their right to apply for funds and may choose instead to waive their allocation back to the State or to another entity. The grant applicant that is requesting CJD funding is responsible for obtaining the written authorization from each entity that chooses to waive their allocation to the applicanfs organization. In addition, the grant applicant is responsible for forwarding this signed document at the same time that the Grant Application Certification Form is submitted to CJD via facsimile or mail. CJD will not award any additional waived funds to the applicant organization until the waiver form is signed and received by CJD via facsimile or mail. PART I: WAIVER OF ALLOCATION 1. Does the entitv choose to waive their allocation to CJD? I [J I Yes I Ll I No 2. Does the entitv choose to waive their allocation to another entity? I I I I Yes I rl I No 3. If vou selected 'Ves', for either # 1 or # 2 above, PROVIDE the followino information: a\ The Name of EnillVWaivino Funds: I bl The waived funds amount (Sl: I c) The name of the organization that will receive the allocation waived I bv vour entitv: d) If funds are being waived to more than one organization, ENTER the additional name(s) of the organization(s) receivino funds and the amount of the waived funds: Namels} of the Entitv/ies} Receivina Waived Funds Waived Funds Amount IS} PART II: SIGNATURE AUTHORIZING THE WAIVER OF ALLOCATION The above-named entity waiving the allocation understands that if funds are waived to the Governor's Office, Criminal Justice Division (CJD), that those funds may be earmarked at the discretion of the executive director. Or, if funds are waived to another entity, the above-named entity waiving funds understands that those funds may be used to provide eligible services to organization(s) that are eligible for their own separate grant The entity waiving funds hereby authorizes the above-named organization(s) to receive the allocated funds that were initially dedicated to our organization in effect on the date this form is signed by the authorizing official as listed below. Name of the Waiving Entity Name of the Entity's Authorized Official Title of the Entity's Authorized Official Effective Date Signature of the Entity's Authorized Official CJO GRANT ApPlICA TlON KIT - PAGE 26 JABG (CFOA-16.523) ISSUE OA re: OCTOBER 2003 EXHIBIT Jl.