FLORIDA DEPARTMENT OF EDUCATION

PROJECT APPLICATION

 

Please return to:

 

Florida Department of Education

Bureau of Grants Management

Room 325 Turlington Building

325 West Gaines Street

Tallahassee, Florida 32399-0400

Telephone: (850) 487-3520

Suncom: 277-3520

 

A

)

Program Name:

 

 

 

Title IV Community Service

Grants

 

DOE USE ONLY

 

Date Received

 

 

 

 

 

 

B) Name and Address of Eligible Applicant:

 

 

 

 

 

Project Number (DOE Assigned)

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

C

)

Total Funds Requested:

 

 

$

 

 

 

DOE USE ONLY

 

 

Total Approved Project:

 

$

TAPS Number

3C080

DOE 100A

Revised 03/02 Page 1 of 2

 

Charlie Crist, Commissioner

  

---

DOE 100A

Revised 03/02 Page 2 of 2

 

Charlie Crist, Commissioner

 

 

Instructions for Completion of DOE 100A

 

 

 

A.

If not pre-printed, enter name of the program for which funds are requested.

 

B.

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.

Enter the total amount of funds requested for this project.

 

D.

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.

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.

 

•

 

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.