PY 2019-2020 CDBG PUBLIC SERVICES
REQUEST FOR FUNDING
PROPOSAL ABSTRACT
Agency Name
Agency Address
Director's Name E-Mail Address
Project Name
Contact's Name
Contact's Address
Phone Number Fax Number
E-Mail Address Web Page Address
DCHD Service Category Target Population
# total clients for project/
# DCHD clients for project
Project (“New” = not currently
in operation)
New Existing
Number of Years Agency
has been funded by
DCHD
Number of years Project has
been funded by DCHD to date
Amount Requested: Total Project Budget:
Project Summary:
Describe the proposed project. Please note that this summary will be used to describe your project in official City documents.
Budget Summary:
Describe the budget for the project and show how the budget relates to the requested funding.
I certify that I am authorized to sign legal documents on behalf of this organization.
I certify that the information contained in this funding application is true and correct.
Signature and Printed Name Title Date
click to sign
signature
click to edit
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