________________________________________________
FLORIDA DEPARTMENT OF EDUCATION
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PROJECT APPLICATION
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TAPS Number
06B004
Please return to:
Florida Department of Education
Bureau of Grants Management
Room
325B
Turlington Building
325 West Gaines Street
Tallahassee, Florida 32399-0400
Telephone: (850) 245-0498
Suncom: 205-0498
A
)
Program Name:
21
st
Century Community Learning Centers
Program - Competitive
DOE USE ONLY
Date Received
B) Name and Address of Eligible Applicant:
Project Number (DOE Assigned)
C
)
Total Funds Requested:
$
DOE USE ONLY
Total Approved Project:
$
D
)
Applicant Contact Information
Contact Name:
Mailing Address:
Telephone Number:
SunCom Number:
Fax Number:
E-mail Address:
CERTIFICATION
I, ______________________________________________, (
Please Type Name)
do hereby certify that all facts, figures, and
representations made in this application are true, correct, and consistent with the statement of general assurances and specific
programmatic assurances for this project. Furthermore, all applicable statutes, regulations, and procedures; administrative and
programmatic requirements; and procedures for fiscal control and maintenance of records will be implemented to ensure proper
accountability for the expenditure of funds on this project. All records necessary to substantiate these requirements will be
available for review by appropriate state and federal staff. I further certify that all expenditures will be obligated on or after the
effective date and prior to the termination date of the project. Disbursements will be reported only as appropriate to this project,
and will not be used for matching funds on this or any special project, where prohibited.
Further, I understand that it is the responsibility of the agency head to obtain from its governing body the authorization for the
submission of this application.
E)
Signature of Agency Head
DOE 100A
Revised 01/03
Page 1 of 2
John L. Winn, Commissioner
Instructions for Completion of DOE 100A
A.
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If not pre-printed, enter name of the program for which funds are requested.
B.
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Enter name and mailing address of eligible applicant. The applicant is the public or non-public
entity receiving funds to carry out the purpose of the project.
C.
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Enter the total amount of funds requested for this project.
D.
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Enter requested information for the applicant’s contact person. This is the person responsible for
responding to all questions regarding information included in this application.
E.
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The original signature of the appropriate agency head is required.
The agency head is the
school district superintendent, university or community college president, state agency
commissioner or secretary, or the president/chairman of the Board for other eligible applicants.
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Note:
Applications signed by officials other than the appropriate agency head identified above
must have a letter signed by the agency head, or documentation citing action of the governing body
delegating authority to the person to sign on behalf of said official. Attach the letter or
documentation to the DOE 100A when the application is submitted.
DOE 100A
Revised 01/03
Page 2 of 2
John L. Winn, Commissioner
