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2. Division applying for grant:*
3. Contact Person for Project:*
5. Name of the grant:*
6. Agency providing funds:*
8. Grant Source:*

   1. Federal
   2. State
   3. Other
9. If other, please specify:
11. Date grant application is due:
    Date grant application is due:

    Date grant application is due:
12. Date of submittal to Finance for review:
    Date of submittal to Finance for review:

    Date of submittal to Finance for review:
14. Purpose of the grant:*
16. Total grant amount:*

    $$

17. Dates grant money can be spent:*
    Dates grant money can be spent:

    Dates grant money can be spent:

    MM/DD/YY to MM/DD/YY

19. Is this a recurring grant (does the County apply and receive it every year)?*

    1. Yes
    2. No
20. Local match amount (if any):*

    $$

22. Is the match appropriated?*

    1. Yes
    2. No
23. If yes, source of the local match:
25. Year local match will be spent:*

    (YYYY)

26. Are there capital expenses included in the application?*

    1. Yes
    2. No
28. If yes, please explain:
30. Are there any ongoing expenses associated with the project that would not be covered by the grant? Examples might be ongoing software or maintenance agreements, or equipment or supplies required for the project to be successful that would not be grant funded?*

    1. Yes
    2. No
32. If yes, please explain and include estimated costs:
34. Are any other agencies involved in this grant?*

    1. Yes
    2. No
36. If yes, who?
38. Was this application adopted as part of the County’s budget?*

    1. Yes
    2. No
40. If the project or application was not contemplated in the County’s adopted budget, did the BOCC approve the application as part of a specific Board meeting?*

    1. Yes
    2. No
42. If yes, what was the date of BOCC Meting?
    If yes, what was the date of BOCC Meting?

    If yes, what was the date of BOCC Meting?
44. In the event grant dollars are not received for this project, will work continue without funding?*

    1. Yes
    2. No
46. Remember that the Board of County Commissioners must approve any grant application with a request for greater than $100,000 (including match) before it is submitted to the granting agency.

    This form also requires signatures of the Grant Designee, Division Head,  County Manager,  and Finance Dept. 

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48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field