<table>
<colgroup>
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 21%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="24"></td>
<td colspan="12"></td>
<td colspan="4"><strong>(Certified Current 5/10/07)</strong></td>
</tr>
<tr class="even">
<td colspan="24"><p><strong>APPLICATION FOR</strong></p>
<p><strong>FEDERAL ASSISTANCE</strong></p></td>
<td colspan="12"><p><strong>2. DATE SUBMITTED</strong></p>
<p><strong>     </strong></p></td>
<td colspan="4"><p>Applicant Identifier</p>
<p><strong>     </strong></p></td>
</tr>
<tr class="odd">
<td colspan="10" rowspan="2"><p>1. TYPE OF SUBMISSION:</p>
<p>Application</p>
<p> <strong>Construction</strong></p>
<p> <strong>Non-Construction</strong></p></td>
<td colspan="14" rowspan="2"><p>Preapplication</p>
<p> <strong>Construction</strong></p>
<p> <strong>Non-Construction</strong></p></td>
<td colspan="12"><p><strong>3. DATE RECEIVED BY STATE</strong></p>
<p><strong>     </strong></p></td>
<td colspan="4"><p>State Application Identifier</p>
<p><strong>     </strong></p></td>
</tr>
<tr class="even">
<td colspan="12"><p><strong>4. DATE RECEIVED BY FEDERAL
AGENCY</strong></p>
<p><strong>     </strong></p></td>
<td colspan="4"><p>Federal Identifier</p>
<p><strong>     </strong></p></td>
</tr>
<tr class="odd">
<td colspan="40"><strong>5. APPLICANT INFORMATION</strong></td>
</tr>
<tr class="even">
<td colspan="30" rowspan="2"><p>Legal Name:</p>
<p><strong>     </strong></p></td>
<td colspan="10"><strong>Organizational Unit:      </strong></td>
</tr>
<tr class="odd">
<td colspan="10">Department: <strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="30">Organizational DUNS: <strong>     </strong></td>
<td colspan="10">Division: <strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="30"><h1 id="address">Address: </h1></td>
<td colspan="10" rowspan="2"><strong>Name and telephone number of person
to be contacted on matters involving this application (give area
code)</strong></td>
</tr>
<tr class="even">
<td colspan="30" rowspan="2"><h1 id="street">Street:      </h1></td>
</tr>
<tr class="odd">
<td colspan="5">Prefix: <strong>     </strong></td>
<td colspan="5">First Name: <strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="30"><h1 id="city">City:      </h1></td>
<td colspan="10">Middle Name: <strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="30"><h1 id="county">County:      </h1></td>
<td colspan="10">Last Name: <strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="13"><h1 id="state">State:      </h1></td>
<td colspan="17"><h1 id="zip-code">Zip Code:      </h1></td>
<td colspan="10"><h1 id="suffix">Suffix:      </h1></td>
</tr>
<tr class="odd">
<td colspan="30"><h1 id="country">Country :      </h1></td>
<td colspan="10"><h1 id="email">Email:      </h1></td>
</tr>
<tr class="even">
<td colspan="30"><h1 id="employer-identification-number-ein">6. EMPLOYER
IDENTIFICATION NUMBER <em>EIN</em>):</h1></td>
<td colspan="7"><h1 id="phone-number-give-area-code">Phone number (give
area code): </h1></td>
<td colspan="3"><h1 id="fax-number-give-area-code">FAX number (give area
code): </h1></td>
</tr>
<tr class="odd">
<td></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong>-</strong></td>
<td><strong> </strong></td>
<td colspan="2"><strong> </strong></td>
<td colspan="2"><strong> </strong></td>
<td colspan="3"><strong> </strong></td>
<td colspan="3"><strong> </strong></td>
<td colspan="2"><strong> </strong></td>
<td colspan="3"><strong> </strong></td>
<td colspan="3"><strong> </strong></td>
<td colspan="7"></td>
<td colspan="7"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="30" rowspan="3"><p>8. TYPE OF APPLICATION:</p>
<p> New Continuation Revision</p></td>
<td colspan="10"><strong>7. TYPE OF APPLICANT: (See back of form for
Application Types)</strong></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2"><strong> </strong></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td colspan="10" rowspan="2">Other (specify) <strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="19" rowspan="2"><p>If Revision, enter appropriate letter(s)
in box(es):</p>
<p>(See back of form for description of letters)</p></td>
<td colspan="3" rowspan="2"></td>
<td colspan="5" rowspan="2"></td>
<td colspan="2" rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="even">
<td colspan="10" rowspan="2"><p><strong>9. NAME OF FEDERAL
AGENCY</strong></p>
<p><strong>     </strong></p></td>
</tr>
<tr class="odd">
<td colspan="30">Other <em>(specify)</em></td>
</tr>
<tr class="even">
<td colspan="30"><strong>     </strong></td>
<td colspan="10" rowspan="5"><p><strong>11. DESCRIPTIVE TITLE OF
APPLICANT'S PROJECT:</strong></p>
<p><strong>     </strong> :</p></td>
</tr>
<tr class="odd">
<td colspan="30"><strong>10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE
NUMBER</strong></td>
</tr>
<tr class="even">
<td colspan="16"></td>
<td colspan="2"><strong> </strong></td>
<td colspan="3"><strong> </strong></td>
<td colspan="3"><strong>-</strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td colspan="2"><strong> </strong></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="16">TITLE: <strong>     </strong></td>
<td colspan="14"></td>
</tr>
<tr class="even">
<td colspan="30"><p><strong>12. AREAS AFFECTED BY PROJECT</strong>
<em>(cities, counties, states, etc.):</em></p>
<p><strong>     </strong></p></td>
</tr>
<tr class="odd">
<td colspan="30"><strong>13. PROPOSED PROJECT</strong></td>
<td colspan="10"><strong>14. CONGRESSIONAL DISTRICTS OF</strong></td>
</tr>
<tr class="even">
<td colspan="14"><p>Start Date</p>
<p><strong>     </strong></p></td>
<td colspan="16"><p>Ending Date</p>
<p><strong>     </strong></p></td>
<td colspan="9"><p>a. Applicant</p>
<p><strong>     </strong></p></td>
<td><p>b. Project</p>
<p><strong>     </strong></p></td>
</tr>
<tr class="odd">
<td colspan="26"><strong>15. ESTIMATED FUNDING</strong></td>
<td colspan="4"></td>
<td colspan="10"><p><strong>16. IS APPLICATION SUBJECT TO REVIEW BY
STATE</strong></p>
<p><strong>EXECUTIVE ORDER 12372 PROCESS</strong></p></td>
</tr>
<tr class="even">
<td colspan="6">a. Federal</td>
<td colspan="2">$</td>
<td colspan="18"><strong>     </strong></td>
<td colspan="4"><strong><sup>.00</sup></strong></td>
<td rowspan="2">a. Yes.</td>
<td colspan="2" rowspan="2"></td>
<td colspan="7" rowspan="2"><p>THIS PREAPPLICATION/APPLICATION WAS MADE
AVAILABLE TO THE STATE EXECUTIVE ORDER 12372</p>
<p>PROCESS FOR REVIEW ON</p></td>
</tr>
<tr class="odd">
<td colspan="6">b. Applicant</td>
<td colspan="2">$</td>
<td colspan="18"><strong>     </strong></td>
<td colspan="4"><strong><sup>.00</sup></strong></td>
</tr>
<tr class="even">
<td colspan="6">c. State</td>
<td colspan="2">$</td>
<td colspan="18"><strong>     </strong></td>
<td colspan="4"><strong><sup>.00</sup></strong></td>
<td></td>
<td colspan="2"></td>
<td colspan="7">DATE: <strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="6">d. Local</td>
<td colspan="2">$</td>
<td colspan="18"><strong>     </strong></td>
<td colspan="4"><strong><sup>.00</sup></strong></td>
<td>b. No.</td>
<td colspan="2"></td>
<td colspan="7">PROGRAM IS NOT COVERED BY E. O. 12372</td>
</tr>
<tr class="even">
<td colspan="6">e. Other</td>
<td colspan="2">$</td>
<td colspan="18"><strong>     </strong></td>
<td colspan="4"><strong><sup>.00</sup></strong></td>
<td></td>
<td colspan="2"></td>
<td colspan="7">OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR
REVIEW</td>
</tr>
<tr class="odd">
<td colspan="6">f. Program income</td>
<td colspan="2">$</td>
<td colspan="18"><strong>     </strong></td>
<td colspan="4"><strong><sup>.00</sup></strong></td>
<td colspan="10"><strong>17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL
DEBT</strong>?</td>
</tr>
<tr class="even">
<td colspan="6">g. TOTAL</td>
<td colspan="2">$</td>
<td colspan="18"><strong>     </strong></td>
<td colspan="4"><strong><sup>.00</sup></strong></td>
<td colspan="10">Yes If “Yes” attach an explanation No</td>
</tr>
<tr class="odd">
<td colspan="40"><strong>18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL
DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, THE
DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT
AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE
ASSISTANCE IS AWARDED.</strong></td>
</tr>
<tr class="even">
<td colspan="40">a. Authorized Representative</td>
</tr>
<tr class="odd">
<td colspan="11">Prefix <strong>     </strong></td>
<td colspan="23">First Name <strong>     </strong></td>
<td colspan="6">Middle Name <strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="34">Last Name <strong>     </strong></td>
<td colspan="6">Suffix <strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="34">b. Title <strong>     </strong></td>
<td colspan="6"><p>c. Telephone number (give area code)</p>
<p><strong>     </strong></p></td>
</tr>
<tr class="even">
<td colspan="34">d. Signature of Authorized Representative</td>
<td colspan="6">e. Date Signed <strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="16"><p>Previous Editions Not Usable</p>
<p>Authorized for Local Reproduction</p></td>
<td colspan="22"></td>
<td colspan="2"><p>Standard Form 424 (Rev.9-2003)</p>
<p>Prescribed by OMB Circular A-102</p></td>
</tr>
</tbody>
</table>

INSTRUCTIONS FOR THE SF 424

<table>
<colgroup>
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 14%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 18%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 17%" />
<col style="width: 27%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="12"><p>Public reporting burden for this collection of
information is estimated to average 45 minutes per response, including
time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing
the collection of information. Send comments regarding the burden
estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the Office of
Management and Budget, Paperwork Reduction Project (0348-0043),
Washington, DC 20503.</p>
<p><strong>PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF
MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING
AGENCY.</strong></p></td>
</tr>
<tr class="even">
<td colspan="12">This is a standard form used by applicants as required
facesheet for preapplications and applications submitted for Federal
assistance. It will be used by Federal agencies to obtain applicant
certification that States which have established a review and comment
procedure in response to Executive Order 12372 and have selected the
program to be included in their process, have been given an opportunity
to review the applicant's submission.</td>
</tr>
<tr class="odd">
<td><strong>Item</strong></td>
<td colspan="6"><strong>Entry:</strong></td>
<td colspan="2">Item</td>
<td colspan="3"><strong>Entry:</strong></td>
</tr>
<tr class="even">
<td>1.</td>
<td colspan="6">Select Type of Submission.</td>
<td colspan="2">11.</td>
<td colspan="3">Enter a brief descriptive title of the project. If more
than one program is involved, you should append an explanation on a
separate sheet. If appropriate (e.g. construction or real property
projects), attach a map showing project location. For preapplications,
use a separate sheet to provide a summary description of this
project.</td>
</tr>
<tr class="odd">
<td>2.</td>
<td colspan="6">Date application submitted to Federal agency (or State
if applicable) &amp; applicant's control number (if applicable).</td>
<td colspan="2">12.</td>
<td colspan="3">List only the largest political entities affected (e.g.,
State, counties, cities).</td>
</tr>
<tr class="even">
<td>3.</td>
<td colspan="6">State use only (if applicable)</td>
<td colspan="2">13.</td>
<td colspan="3">Enter the proposed start date and end date of the
project.</td>
</tr>
<tr class="odd">
<td>4.</td>
<td colspan="6"><p>Enter Date Received by Federal Agency</p>
<p>Federal identifier number: If this application is a continuation or
revision to an existing award, enter the present Federal Identifier
number. If for a new project, leave blank.</p></td>
<td colspan="2">14.</td>
<td colspan="3">List the applicant's Congressional District and any
District(s) affected by the program or project.</td>
</tr>
<tr class="even">
<td>5.</td>
<td colspan="6">Enter legal name of applicant, name of primary
organizational unit (including division, if applicable), which will
undertake the assistance activity, enter the organization’s DUNS number
(received from Dun and Bradstreet), enter the complete address of the
applicant (including country), and name, telephone number, e-mail, and
fax of the person to contact on matters related to this
application.</td>
<td colspan="2">15.</td>
<td colspan="3">Amount requested or to be contributed during the first
funding/budget period by each contributor. Value of in-kind
contributions should be included on appropriate lines as applicable. If
the action will result in a dollar change to an existing award, indicate
<u>only</u> the amount of the change. For decreases, enclose the amounts
in parentheses. If both basic and supplemental amounts are included,
show breakdown on an attached sheet. For multiple program funding, use
totals and show breakdown using same categories as item 15.</td>
</tr>
<tr class="odd">
<td>6.</td>
<td colspan="6">Enter Employer Identification Number (EIN) as assigned
by the Internal Revenue Service.</td>
<td colspan="2">16.</td>
<td colspan="3">Applicants should contact the State Single Point of
Contact (SPOC) for Federal Executive Order 12372 to determine whether
the application is subject to the State intergovernmental review
process.</td>
</tr>
<tr class="even">
<td rowspan="2">7.</td>
<td colspan="3">Enter the appropriate letter in the space provided.</td>
<td rowspan="2"><p>I.</p>
<p>J.</p>
<p>K.</p>
<p>L.</p>
<p>M.</p>
<p>N.</p>
<p>O.</p></td>
<td colspan="3" rowspan="2"><p>State Controlled</p>
<p>Institution of Higher</p>
<p>Learning</p>
<p>Private University</p>
<p>Indian Tribe</p>
<p>Individual</p>
<p>Profit Organization</p>
<p>Other (Specify)</p>
<p>Not for Profit Organization</p></td>
<td colspan="2" rowspan="2">17.</td>
<td colspan="2" rowspan="2">This question applies to the applicant
organization, not the person who signs as the authorized representative.
Categories of debt include delinquent audit disallowances, loans and
taxes.</td>
</tr>
<tr class="odd">
<td><p>A.</p>
<p>B.</p>
<p>C.</p>
<p>D.</p>
<p>E.</p>
<p>F.</p>
<p>G.</p>
<p>H.</p></td>
<td colspan="2"><p>State</p>
<p>County</p>
<p>Municipal</p>
<p>Township</p>
<p>Interstate</p>
<p>Intermunicipal</p>
<p>Special District</p>
<p>Independent School</p>
<p>District</p></td>
</tr>
<tr class="even">
<td rowspan="3">8.</td>
<td colspan="6" rowspan="2"><p>Select type from the following list:</p>
<ul>
<li><p>"New" means a new assistance award.</p></li>
<li><p>"Continuation" means an extension for an additional
funding/budget period for a project with a projected completion
date.</p></li>
<li><p>"Revision" means any change in the Federal Government's financial
obligation or contingent liability from an existing obligation. If a
revision enter the appropriate letter:</p></li>
</ul></td>
<td colspan="2" rowspan="3">18.</td>
<td colspan="3" rowspan="3">To be signed by the authorized
representative of the applicant. A copy of the governing body's
authorization for you to sign this application as official
representative must be on file in the applicant's office. (Certain
Federal agencies may require that this authorization be submitted as
part of the application.)</td>
</tr>
<tr class="odd">
</tr>
<tr class="even">
<td colspan="2"></td>
<td><p>A. Increase Award</p>
<p>C. Increase Duration</p></td>
<td colspan="3"><blockquote>
<p>B. Decrease Award</p>
<p>D. Decrease Duration</p>
</blockquote></td>
</tr>
<tr class="odd">
<td>9.</td>
<td colspan="6">Name of Federal agency from which assistance is being
requested with this application.</td>
<td colspan="2"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td>10.</td>
<td colspan="6">Use the Catalog of Federal Domestic Assistance number
and title of the program under which assistance is requested.</td>
<td colspan="2"></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="5"></td>
<td colspan="5"></td>
<td><h2 id="sf-424-rev.-7-97-back">SF-424 (Rev. 7-97) Back</h2></td>
</tr>
</tbody>
</table>