Fillable Grants Gatew ay Registration Form for A d (New York State)

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Grants Gatew ay Registration Form for A d (New York State)

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Grants Gatew
ay
Registration Form for A
d
m
inist
r
ato
rs
Page 1 of 2
Grants Management - Registration Form for Administrator (03/27/2020)
Organization Information
Legal Name
Doing Business As (DBA) Name (if applicable)
Federal ID
SFS Vendor ID (if applicable)
DUNS Number (if applicable)
Street Address 1
Street Address 2
City
State
Zip
Organization Type
Check one:
Request
**
Delegated Administrators
Last Name
First Name
Title
Phone Number
Email*
Last Name
First Name
Title
Phone Number
Email*
Authorization
This section is to be completed by the Head of the Organization (i.e. Executive Director or comparable title). I
hereby authorize
the Delegated Administrators identified above to manage users within the Grants Gateway on
behalf of my organization. I understand that my organization is solely responsible for all activities undertaken
within the Grants Gateway by users associated with my organization.
Head of Organization
Title
Phone Number
Email*
Signature
Date
Acknowledgement to be completed by a Notary Public**
State of**
County of**
On the**
day of**
in the year**
before me, the undersigned, personally appeared ** ___________________________________ personally known to me
or proved to me on the
basis of satisfactory evidence to be the individual whose name is subscribed to the
within
instrument and acknowledged
to me that he/she executed the same in his/her capacity, and that by his/her signature on
the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument.
Notary Public Signature
Notary Public Stamp
*This should be an individual email address; confidential user information will be sent to this address
** See Instructions, Page 2
Not for Profit
For Profit
Governmental Entity
Prequalification Exempt Individual
Tribal Organization
Grants Gatew
ay
Registration Form for A
d
m
inist
r
ato
rs
Page 2 of 2
Grants Management - Registration Form for Administrator (09/03/2021)
Form Instructions
ALL INFORMATION ON THE FORM IS REQUIRED, UNLESS EXPLICITLY INDICATED OTHERWISE.
Organization Information
• Legal Name - Enter as it appears on the Articles of incorporation or Business Certification.
• Doing Business As (DBA) Name - Enter if your organization is doing business under a name other than the
Legal Name shown above.
• Federal ID - Enter your 9-digit Federal ID.
• SFS Vendor ID - Enter your 10 digit SFS Vendor ID. If your organization does not have an SFS Vendor ID you
will have to submit a completed Substitute W-9 form with this form. You can get a copy of the Substitute W-9
form at http://www.osc.state.ny.us/vendors/forms/ac3237s_fe.pdf.
• DUNS Number - Enter your organizations 9 digit DUNS Number if it has one.
•
Address - Enter your address.
Organization Type
•
Select one Organization Type
• Generally, nonprofit organizations must meet Prequalification requirements prior to applying for
grants and receiving contracts. However, certain categories of nonprofits are exempt from this
requirement. A complete listing of exemption types and an Exemption Request form is available
online. If your organization meets the requirements for an exemption, check the “Prequalification
Exemption Request” box. Note that a complete Exemption Request Form and the required supporting
documentation, available and listed on the website, must accompany the Registration Form for
Administrator.
Delegated Administrators
• All organizations wishing to utilize the Grants Gateway must designate two Delegated Administrators to
authorize and monitor access to the system for your organization. Two Delegated Administrators are
necessary in order to provide both backup and continuity for your organization. In addition, if a Delegated
Administrator leaves your organization the second Delegated Administrator is your only user with the
authorization to inactivate the Delegated Administrator who left.
• The Delegated Administrator is responsible for maintaining all aspects of the organization's user
information. This includes adding users, assigning roles, ensuring user's information is current and
deactivating users in a timely fashion, if necessary.
• Enter the Last Name, First Name, Title, Phone Number and Email Address for each Delegated
Administrator. The Email Address should belong to an individual, since confidential information (including
usernames and passwords) will be sent to this address. An organization email address accessible by
multiple persons should not be used.
Authorization
• This section must contain information on the Head of the Organization - Chief Administrative Officer, Executive
Director, CEO
or comparable title.
• Enter the Last Name, First Name, Title, Phone Number and Email Address for the Head of the Organization.
•
The Head of the Organization must sign and date the form.
Acknowledgement to be completed by a Notary Public
• This section must be completed by a Notary Public.
Submission Instructions
• Scan the completed, signed, and notarized form and email it to grantsreform@its.ny.gov.
• Include an organization chart that shows the Head of your Organization.
• New Vendors must request an SFS ID. Include a completed copy of Substitute W-9 with this submission.
• If you need assistance email grantsreform@its.ny.gov.
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Grants Gatew ay Registration Form for A d (New York State)

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Completed 4 April 2022

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