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<br />Email Address: <br /> <br /> <br />Fiscal Contact Name: <br /> <br />Phone: <br /> <br />Email Address: <br /> <br /> <br />Name and Title of Authorized Representative: <br /> <br />Acceptance of this application may be subject to subsequent compliance reviews, including a review <br />of the latest audit of financial statement. Preparation of an application does not guarantee that <br />applicants will receive funds. By signing this grant application form the undersigned certifies that all <br />information is accurate to the best of his/her knowledge. <br /> <br /> <br />__________________________________ ____________ <br />Signature of Authorized Representative Date <br /> <br />PROPOSAL DETAILS <br />1. Applicant Profile and Qualifications: Tell us briefly about your organization including <br />your mission, your goals, any history, and years of experience providing services for <br />individuals with developmental disabilities, experience managing public funds, and <br />anything else that describes the organization’s qualifications. (max. 250 words) <br /> <br />2. Project Description Summary: Indicate how the proposed activities meet the <br />requirements of the information and education funds (see Section 1 of the RFP) and <br />provide a brief summary and general description of the activities being proposed. <br />Include how many people will be served or reached. Indicate all areas that apply. (max. <br />250 words each area) <br /> <br /> Community Information and Education: <br /> Training <br />i. Staff training: <br />ii. Board Training: <br /> Other Activities <br />i. Infrastructure projects: <br />ii. Startup projects: <br />iii. Partnership projects: <br />