Jasper County Sheltered Facilities Board Return to Home Page
2004-2005 Request for Funding (RFF)
Board Resolution
At the Board meeting on ____________________, 20___,
the Board of Directors of
_________________________________________ approved
submitting this Application
(Name
of Agency Applying for funds)
for Funds to the Jasper County Sheltered Facilities
Board of Jasper County.
The total amount of the request is $________________
for the purpose of:
Project
Name Amount
Requested
_______________________________ ___________________________
_______________________________ ___________________________
_______________________________ ___________________________
_______________________________ ___________________________
_______________________________ ___________________________
_______________________________ ___________________________
_______________________________ ___________________________
_______________________________ ___________________________
_______________________________ ___________________________
_______________________________ ___________________________
Note: Exact
dollars requested are not required.
Amounts requested should be submitted as not-to-exceed figures.
The authorized individual(s) to enter into contractual
arrangements with the Jasper County Sheltered Facilities Board of Jasper County
is (are):
_______________________________________________
_______________________________________________
_______________________________________________
We, the undersigned, hereby certify that the
statements made in the application are correct to the best of our knowledge and
belief, and we are authorized to sign this application on behalf of the
applicant, and we shall comply with the Jasper County Sheltered Facilities
Board's guidelines, monitoring procedures, and formal contract provisions if
our request for funding is approved.
Respectfully Submitted:
By: ____________________________
Title:
___________________________, Board of Directors
Date:
___________________________