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Host Site Information
*
1.
I have read and understand the
Community Sponsor Information
including the obligations of a sponsor organization.
If you have questions about these obligations, please reach out to Maureen.Kendzierski@maine.gov before proceeding with your application.
(Required.)
Yes
No
2.
Contact Information
Name of Project Contact
Organization
Street Address
PO Box/Other
City/Town
State
ZIP Code
Email Address
Phone Number
*
3.
Organization Employer Identification Number (EIN):
(Required.)
4.
Organization website URL:
*
5.
Select the applicant's type of organization.
(Required.)
Nonprofit
State, county or local government
Educational institution
Faith-based organization
Tribal government
Regional organization
Other (please specify)
*
6.
Does your organization have regular audits performed?
(Required.)
Yes
No
7.
Audit details
If "YES", how often and who does it?
If "NO", who reviews agency financial reports and how often?
Documents required with application. Upload these on the final page of this online form.
A staff organizational chart
List of governing board members, county commissioners, town council members (whatever is applicable)
Proof of organizational eligibility (IRS letter with tax exempt status OR W9)
Attachment A: Project Work Plan
