KCDD Unsolicited Project Application

1. Grant Application Face Sheet

Question Title

* 1. Applicant Agency/Organization's Legal Name

Applicant Agency

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Implementing Agency/Organization's Legal Name

Implementing Agency

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 3. Fiscal Agent (if a Fiscal Agent is used to handle funds or sign contracts on your behalf).

Fiscal Agent

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 4. Authorizing Official

Question Title

* 5. Federal Employer ID Number (FEIN)

Question Title

* 6. Project Director

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 7. Project Title and Summary (Identify target audience, numbers to benefit, and expected outcomes)

Project Title

Target Audience

Number of people expected to benefit from the project

Expected Outcomes

Question Title

* 8. Support Requested (Agency/Source) Please enter dollar amounts

KCDD

Applicant (Cash and In-Kind)

Other Sources

Total Project Cost

Question Title

* 9. Organization Type

Public

Private Non-Profit

Private For-Profit

Question Title

* 10. Grant Period

Question Title

* 11. Fiscal Year End Date

Question Title

* 12. Council Goal Area Addressed by Proposal

Self Advocacy

Employment

Education

Quality Assurance

Question Title

* 1. Applicant Agency/Organization's Legal Name

Question Title

* 2. Implementing Agency/Organization's Legal Name

Question Title

* 3. Fiscal Agent (if a Fiscal Agent is used to handle funds or sign contracts on your behalf).

Question Title

* 4. Authorizing Official

Question Title

* 5. Federal Employer ID Number (FEIN)

Question Title

* 6. Project Director

Question Title

* 7. Project Title and Summary (Identify target audience, numbers to benefit, and expected outcomes)

Question Title

* 8. Support Requested (Agency/Source) Please enter dollar amounts

Question Title

* 9. Organization Type

Question Title

* 10. Grant Period

Question Title

* 11. Fiscal Year End Date

Question Title

* 12. Council Goal Area Addressed by Proposal

Question Title

* 13. Kansas Counties to be served by Project