PY2011 CM Application Form.doc - Alabama



SMALL CITY, LARGE CITY, AND COUNTY FUNDS APPLICATION

ALABAMA COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

PROGRAM YEAR 2021

FORWARD AN ORIGINAL AND TWO COPIES OF

THE FULL APPLICATION PACKAGE TO

CDBG Section

ALABAMA DEPARTMENT OF ECONOMIC AND COMMUNITY AFFAIRS

401 ADAMS AVENUE, SUITE 500

POST OFFICE BOX 5690

MONTGOMERY, ALABAMA 36103-5690

Attn: CDBG Application

ALABAMA CDBG APPLICATION SUMMARY FORM

Select One: Select One (if applicable):

_____________________________________________________________________________

|Community Name: |      | |

|Chief Elected Official: |      | |

|Mailing Address: |STREET |      | |

| |CITY |      |ST |AL |ZIP |      | |

|Phone Number: |      |E-mail Address: |      |

|COUNTY: |      |FEIN: |      |

|DUNS No.: |      | Expiration Date: |      |

|Amount Requested: |$ |      |2010 Census Population: | |

|Local Match: |$ |      |Cash: |$ |      |Source: |      |

| | | |In-Kind: |$ |      |Source: |      |

|Non-Local Funds: |$ |      |Source: |      |

|Federal Congressional District: |      |/ |      |

|State District: |(Senate) |      |/ |      |/ |

|Prevention of Slum and Blight: | |Yes | |No |No. of Units Rehab/Demo: |      |

|Contact Person/Grant Writer: |      |

|Firm or Organization: |      |

|Mailing Address: |      |

|City, State & Zip |STREET |      |ST |      |ZIP |      |

|Phone/E-mail Address: |      |/ |      |

|Select Activity(ies): |

|Activity 1: |      |Activity 2: |      |Activity 3: |      |

|Other/Additional Activity(ies): |      |

|For ADECA Use Only |

|Minority Yes No |Black Belt Yes No | Single/Primary (CM) Comprehensive (CP) |

| | |Residential Rehab (RR) Special Fund (SF) |

|Completed |______________ |AS 400 |______________ |IDIS |______________ |

|Date |______________ |Date |______________ |Date |______________ |

>> PLEASE SEE NEXT PAGE TO COMPLETE APPLICATION FORM ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download