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FEDERAL ASSISTANCE
<br />Address (give city, county, state, and zip code)
<br />1. EMPLOYER IDENTIFICATION NUMBER (EIN):
<br />Z. DATE SUBMITTED '
<br />Applcant Idenlilrer
<br />7. DATE RECEIVED BY STATE
<br />State Application Identifier
<br />4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier
<br />1. TYPE OF APPLICATION:
<br />❑ New ❑ Continuation ❑ Revision
<br />It Revision, enter appropriate letters) in box(es): 11 0
<br />A Increase Award B. Decrease Award C. Increase Duration
<br />D Decrease Duration Other (specify):
<br />10. CATALOG OF FEDERAL DOMESTIC
<br />ASSISTANCE NUMBER:
<br />TITLE:
<br />12. AREAS AFFECTED BY PROJECT (cities, Counties, stales, 01C.)
<br />Organizational Unit:
<br />Name and telephone number of the person to be contacted on matters involving
<br />this application (give area Code)
<br />T. TYPE OF APPLICANT: (enter appropriate letter in box) —ET_
<br />A. Slate H. Independent School Dlsl.
<br />B County 1. State Controlled Institution of Higher Learning
<br />C. Municipal J. Private University
<br />D. Township K. Indian Tribe
<br />E. Interstate L. Individual
<br />F. Inlermunicipal M Profit Organization
<br />G. Special District N. Other (Specify)
<br />9. NAME OF FEDERAL AGENCY: Governor's Office
<br />Criminal Justice Division
<br />P.O. Box'1242�8, Austin, Texas 78711
<br />11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
<br />13. PROPOSED PROJECT: 14. CONGRESSIONAL DISTRICTS OF:
<br />Start Dalee Endmg Date a. Applicant
<br />b. Project
<br />15. ESTIMATED FUNDING; 14. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12772 PROCESS?
<br />a Federal = ,00 a. YES. THIS PREAPPLICATION /APPLICATION WAS MADE AVAILABLE TO THE
<br />STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON
<br />b. Applicant = .00
<br />DATE
<br />C Stale S .00
<br />b NO. PROGRAM IS NOT COVERED BY E O. 12372
<br />d Local f .00
<br />OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW
<br />e Other $ .00
<br />I Program Income S .00 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
<br />rl TOTAL = 00 El Yes It 'Yes.' attach an explanation. No
<br />11. TO THE BEST OF MY KNOWLEDGE AND BELIEF. ALL DATA IN THIS APPLICATION,PREAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS BEEN DULY
<br />AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL-COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED
<br />a Typed Name of Authorized Representative b Title
<br />c Telephone number
<br />d Sgnature of Authorized Representative
<br />e Date Signed
<br />ions Not Usa
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<br />p,esc:ibed by OUB
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<br />1. TYPE OF SUBMISSION:
<br />Application
<br />PreappliCation
<br />❑ Construction
<br />❑ Construction
<br />❑ Non - Construction
<br />❑ Non- Construction
<br />1. APPLICANT INFORMATION
<br />Legal Name.
<br />Address (give city, county, state, and zip code)
<br />1. EMPLOYER IDENTIFICATION NUMBER (EIN):
<br />Z. DATE SUBMITTED '
<br />Applcant Idenlilrer
<br />7. DATE RECEIVED BY STATE
<br />State Application Identifier
<br />4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier
<br />1. TYPE OF APPLICATION:
<br />❑ New ❑ Continuation ❑ Revision
<br />It Revision, enter appropriate letters) in box(es): 11 0
<br />A Increase Award B. Decrease Award C. Increase Duration
<br />D Decrease Duration Other (specify):
<br />10. CATALOG OF FEDERAL DOMESTIC
<br />ASSISTANCE NUMBER:
<br />TITLE:
<br />12. AREAS AFFECTED BY PROJECT (cities, Counties, stales, 01C.)
<br />Organizational Unit:
<br />Name and telephone number of the person to be contacted on matters involving
<br />this application (give area Code)
<br />T. TYPE OF APPLICANT: (enter appropriate letter in box) —ET_
<br />A. Slate H. Independent School Dlsl.
<br />B County 1. State Controlled Institution of Higher Learning
<br />C. Municipal J. Private University
<br />D. Township K. Indian Tribe
<br />E. Interstate L. Individual
<br />F. Inlermunicipal M Profit Organization
<br />G. Special District N. Other (Specify)
<br />9. NAME OF FEDERAL AGENCY: Governor's Office
<br />Criminal Justice Division
<br />P.O. Box'1242�8, Austin, Texas 78711
<br />11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
<br />13. PROPOSED PROJECT: 14. CONGRESSIONAL DISTRICTS OF:
<br />Start Dalee Endmg Date a. Applicant
<br />b. Project
<br />15. ESTIMATED FUNDING; 14. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12772 PROCESS?
<br />a Federal = ,00 a. YES. THIS PREAPPLICATION /APPLICATION WAS MADE AVAILABLE TO THE
<br />STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON
<br />b. Applicant = .00
<br />DATE
<br />C Stale S .00
<br />b NO. PROGRAM IS NOT COVERED BY E O. 12372
<br />d Local f .00
<br />OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW
<br />e Other $ .00
<br />I Program Income S .00 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
<br />rl TOTAL = 00 El Yes It 'Yes.' attach an explanation. No
<br />11. TO THE BEST OF MY KNOWLEDGE AND BELIEF. ALL DATA IN THIS APPLICATION,PREAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS BEEN DULY
<br />AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL-COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED
<br />a Typed Name of Authorized Representative b Title
<br />c Telephone number
<br />d Sgnature of Authorized Representative
<br />e Date Signed
<br />ions Not Usa
<br />C 1�` JD —� aianpafU roan .714 -LV I d8,
<br />p,esc:ibed by OUB
<br />-� 7r,. w,. .,- .s,,: ": n."ix E'• ��Il't�tA:+�,;Ta..i�..�3a"`C `�IS�r'�h \�' �•�: iCw �raY1 '�..ri,.a�f.!".°�..�rA..#�L"ir �l*ea.�:i.._H:i#.r .,is e.�,.�',w �. �',:
<br />
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