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APPLICATION FORM COMMUNITY OUTDOOR OUTREACH PROGRAM

 

I. SPONSOR: ________________________________________________________________

A. Address: ___________________________________________________________

__________________________________________________________________

__________________________________________________________________

B. Federal Tax Identification Code: ___________________________________________

Or 501 C (3) or C (4) exemption (please include your 14-digit tax number)

C. Contact Name & Phone Number: ___________________________________________

II. PROJECT NAME: ___________________________________________________________

 

  1. PROJECT LOCATION:

A. City & County: _____________________________________________________

B. State Legislative District Numbers:

1. Senate ______ 2. House: _______

C. Federal Congressional District Number: ______

 

IV. FUNDS REQUESTED:

A. Sponsor: ____________ (your cash, volunteer and in-kind resources)

B. State: ____________ (funding being requested from TPWD)

C. Total Project: ____________ (total outlay of funds and resources by all parties; A+B)

 

 

* * * * * *

To the best of my knowledge and belief, all documentation is true and correct, the application has been duly authorized by the governing body of the sponsor, and the sponsor agrees to comply with all program rules and procedures if grant assistance is awarded.

 

________________________________________________________________________________

Signature of Official Authorized in Resolution

________________________________________________________________________________

Typed Name, Title and Telephone Number

________________________________________________________________________________

Date