2000 UPDATE RFP - Government of New Jersey



4785360-415925FOR COUNTY USE ONLYApproved: ____ YES _____ NODate:00FOR COUNTY USE ONLYApproved: ____ YES _____ NODate:FORM 1Astrategic plan FOR FUNDING MUNICIPAL ALLIANCESGrant Year: FORMDROPDOWN Alliance Tier _____APPLICANT MUNICIPALITY/IES: FORMTEXT ????? COUNTY: FORMDROPDOWN ALLIANCE? NAME: FORMTEXT ?????ALLIANCE WEBSITE: FORMTEXT ?????ALLIANCE STREET ADDRESS: FORMTEXT ?????TOWN: FORMTEXT ????? STATE: FORMTEXT ?? ZIP: FORMTEXT ?????TELEPHONE: ( FORMTEXT ??? ) FORMTEXT ????? Ext. FORMTEXT ?????FAX: ( FORMTEXT ??? ) FORMTEXT ?????ALLIANCE CHAIRPERSON: FORMTEXT ????? STREET ADDRESS: FORMTEXT ?????TOWN: FORMTEXT ????? STATE: FORMTEXT ?? ZIP: FORMTEXT ?????EMAIL: FORMTEXT ?????ALLIANCE COORDINATOR: FORMTEXT ?????STREET ADDRESS: FORMTEXT ?????TOWN: FORMTEXT ????? STATE: FORMTEXT ?? ZIP: FORMTEXT ?????EMAIL: FORMTEXT ?????DATE OF RESOLUTION AUTHORIZING THE STRATEGIC PLAN (MM/DD/YYYY): FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????A) Alliance DEDR Allocation$ FORMTEXT ?????B) Cash Match (must be 25% of DEDR Allocation)$ FORMTEXT ?????C) In-Kind Match (must be 75% of the DEDR Allocation)$ FORMTEXT ?????TOTAL ALLIANCE BUDGET (add A+ B+C)$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????_________________________ __________________________________ ____________________________*MUNICIPALITYNAME/ MAYOR/Head of Governing Body SIGNATURE FORMTEXT ????? FORMTEXT ?????_________________________ __________________________________ ____________________________*MUNICIPALITYNAME/TITLE OF GOVERNING SIGNATUREBODY REPRESENTATIVE FORMTEXT ????? FORMTEXT ?????_________________________ __________________________________ ____________________________*MUNICIPALITYNAME/TITLE OF GOVERNING SIGNATUREBODY REPRESENTATIVE FORMTEXT ????? FORMTEXT ?????_________________________ __________________________________ ____________________________ALLIANCE CHAIRPERSON SIGNATURE DATE* If a municipality is part of a consortium, a signature and resolution is required from all participating municipalities entering into the agreement. Signatures hereby accept all components of this grant including membership terms, Statement of Assurances and Fiscal Requirements. ................
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