Federal F
iscal Year: 2021
DUE DA
TE: March 13, 2020
Agency:
Agency Name:
Address:
City, State, Zip:
Fax:
Phone:
Title & Name:
Address:
City, State,
Zip:
Phone:
Email:
Title & Name:
Address:
City, State,
Zip:
Phone:
Email:
Please attach a cover letter addressed
to the Director of the Governor’s Office of Highway Safety
on agency letterhead. This cover letter must be signed by a representative of your agency
authorized to commit your agency to conduct the grant should it be approved for funding.
Project Director:
Project Admin:
Financial Contact:
Governmental Unit:
(City, Town, County)
Governmental Name:
Mgr/Supvr Title & Name:
Address:
City, State, Zip:
Chief/Sheriff Title & Name:
Address:
City, State, Zip:
Phone:
Email:
Grant application decisions are reviewed and decided upon by GOHS and include consideration of the
following: analysis of crash data, need for the project, past performance with highway safety grants (if
applicable), and Federal funding availability. Please contact the Arizona Governor’s Office of Highway Safety
at (602) 255-3216 if you need assistance with this application.
SECTION A: Agency Application Information
ARIZONA GOVERNOR'S OFFICE OF HIGHWAY SAFETY
Grant Application for Law Enforcement Projects
EM - Emergency Medical Services
