Fillable NOI Cover Sheet - Part A (Arizona)

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NOI Cover Sheet - Part A (Arizona)

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Country of origin: US
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THIS SECTION FOR STATE USE ONLY
Received By:
Date Received:
Revision Requested:
Point of Contact:
State Hazard Mitigation Officer
Office: 602-464-6349
Email: Lucrecia.Hernandez@azdema.gov
Hazard Mitigation Assistance (HMA)
Notice Of Intent (NOI)
STATE OF ARIZONA
DEPARTMENT OF EMERGENCY AND MILITARY AFFAIRS
NOTE: NOI Cover Sheet -Part A (with original ink signature) must be scanned and emailed as a separate file.
Remainder of NOI form (Part B) must be saved and submitted in original .pdf format (not scanned).
PROJECT OVERVIEW
1. Legal Name:
Organizational Unit:
2. Applicant Type: Local Government State Government
3. Project Title:
4.
$
$
Total Proposed Project Cost:
Federal Share (up to 75%):
Non-Federal Match (at least 25%):
$
5. Certification:
The undersigned assures fulfillment of all requirements of the selected Grant Program as contained in the
program guidelines and that all information contained herein is true and correct to the best of my knowledge.
Typed Name of Authorized Representative
Title
Telephone Number
Signature of Authorized Representative
Date Signed
Final Version:
HMGP
PDM
FMA
SEC
Please select only ONE of the grants programs below. To apply under a different grant program
for the EXACT SAME project, please submit a separate cover sheet.
NOI Cover Sheet - Part A
Multiple Submissions:
Disaster # or Year:
Form version 12-6-17
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NOI Cover Sheet - Part A (Arizona)

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Completed 12 August 2020

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