STATE OF ARIZONA
DEPARTMENT OF EMERGENCY AND MILITARY AFFAIRS
Douglas A. Ducey
GOVERNOR
Major General Michael T. McGuire
THE ADJUTANT GENERAL
R
EQUEST FOR eGRANT ACCESS
For PDM and FMA grants
Submit to: tom.jones@azdema.gov
Name: Email:____________________________
Title: ID #: Office Phone:
Government Entity: Office Fax:
Address:
City:
State: Zip Code:
____________________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ______
Signature of Individual Requesting eGrant Role(s) Date Signed
D
ESCRIPTION OF ROLES
• View/Print: This role is for review purposes only. This will usually include persons who do not need
the authority to physically create or edit an application, nor the right to act as Applicant Agent and
sign or submit the application.
• Create/Edit: This role allows an individual to create or edit applications. This person does not
necessarily need to be intimately involved with the activity’s development, but one able to function
adequately on a computer. In addition, this individual would not normally act as Applicant Agent and
sign or submit the application.
• Sign/Submit: This role is for the Applicant Agent or someone that has been given the authority to act
in his/her stead. This role only allows for the signing of assurances, commitment of funds, and
project submittal to the State
View/Print Create/Edit
Sign/Submit
ROLES REQUESTED
AUTHORIZATION
The undersigned assures the above listed individual is authorized for the role(s) selected
under above listed mitigation grant programs.
________________________________________________________________ _____________________________________ ____________________________
Typed Name of Authorized Representative/Applicant Agent Title Telephone Number
_________________
____________________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ _________ ______________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ ________
Signature of Authorized Representative/Applicant Agency Date Signed
click to sign
signature
click to edit
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