SECTOR PARTNERSHIP — NATIONAL EMERGENCY GRANT
REGIONAL PLANNING AND SECTOR STRATEGIES
Date Received:
Application Number Assigned:
SECTION 1: APPLICANT INFORMATION
1.0 / Legal Name of Applicant Organization:
Address:
City: State: Zip:
1.1 / Please state the name and title of the signatory authority.
Name:
Title:
Phone: Extension: Fax:
E-Mail Address:
1.2 / Project Contact:
Title:
Phone: Extension: Fax:
E-Mail Address:
1.3 / Type of Eligible Organization:
LWIA Collaborative Entity Representing a LWIA(s)
1.4 / Applicant’s FEIN:
Applicant’s DUNS:
1.5 / EDR(s) and/or LWIA(s) Served by Project:
1.6 / Project Title:
1.7 / Are any of the parties participating in this application have a Sector partnership NEG Grant DCEO #15-672XXX?
1.8 / Total Funds Requested:
SECTION 2: PURPOSE AND SCOPE
2.0 / Provide a brief project description (500 words or less) including 1) need; 2) proposed activities; 3) proposed outcomes; and 4) general return on investment:
2.1 / Identify the Sector(s) this Project will Address (if applicable):
2.2 / Can the proposed project be implemented and completed on or before June 30, 2017?
Yes No
2.3 / Does the project offer phases that can be built upon over a period of time if a request for an extension to December 31, 2017 is granted?
Yes No
If yes, please describe the various phases:
Phase 1:
Phase 2:
Phase 3:
Phase 4:
2.4 / Does the project address required revisions the Interagency Work Group (IWG) identified in its review of regional and local plans and MOUs?
Yes No
Please explain:
2.5 / Statement of Work:
Activities: / Timeline (month/year):
SECTION 3: ADDRESSING STATE, REGIONAL AND/OR LOCAL NEEDS
3.0 / Does this project implement and/or address strategies that were identified in the regional/local plan as being incomplete, in Progress, and/or needing additional planning and/or implementation before complete?
Yes No
If yes, please explain:
3.1 / Is the project’s focus targeted on activities that strengthen regional and/or local partnerships?
Yes No
3.2 / Has this proposal been developed and submitted on behalf of a regional, multi-agency planning committee?
Yes No
If yes, please identify multi-agency partners:
If no, please explain:
SECTION 4: BUDGET AND BUDGET NARRATIVE
4.0 / What is the total amount of funds requested for this project? $
4.1: BUDGET
Budget Expenditure (Line Item) / Amounts
1. Personnel (Salaries and Wages)
2. Fringe Benefits
3. Travel
4. Supplies
5. Consultant (Professional Services)
6. Research and Development
7. Training & Education
8. Other Contractual Services and Sub-awards
9. Other Costs – Please list:
Total Amount of Request / $
4.2: BUDGET NARRATIVE
SECTION 5: APPLICANT CERTIFICATION
Under penalty of perjury, I certify that I have examined this application and the document(s), schedule(s), and statement(s) submitted in conjunction herewith, and that, to the best of my knowledge and belief, the information submitted herewith is true, correct, and complete. I represent that I am the person authorized to submit this application on behalf of the applicant, and that I am authorized to execute a legally binding grant agreement on behalf of the applicant if this application is approved for funding.
I hereby release to Man-Tra-Con the rights to and use of photographs and/or any written statements or information, regardless of format (whether they are direct quotes or paraphrased by Man-Tra-Con), contained in or provided after the grant application for the purpose of publication on Man-Tra-Cons website. I hereby also release any and all claims against Man-Tra-Con, its officers, agents, employees and/or affiliates arising out of, or in connection with, the usage of photographs and/or written statements or information, regardless of format (whether they are direct quotes or paraphrased by Man-Tra-Con), for the purpose of publication on Man-Tra-Con’s website.
______
Signature Name & Title Date
Projects are funded by USDOL/ETA funds administered by the
Illinois Department of Commerce which issued a grant to Man-Tra-Con.
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