Enforcement Technology Group, Inc.

APPLICANT INFORMATION:
*First Name:
*Last Name:
*Title:
*Email Address:
*Office Phone:
Cell Phone:
Fax:
AGENCY / ENTITY INFORMATION:
*Agency Legal Name:
*Organization Unit:
*Agency Address:
*Agency City:
*Agency State:
*Postal Code:
*County / Parish:
*Federal Employer Identification Number (FEIN):	9 Digit format
*Applicant Type:
*Congressional District:
*DUNS Number:
DEPARTEMENT HEAD INFORMATION:
*Dept. Head First Name:
*Dept. Head Last Name:
*Dept. Head Title:
Dept. Head Address (If Different):
Dept. Head Address:
Dept. Head City:
Agency State:
Postal Code:
County / Parish:
Dept. Head Contact Info:
**Dept. Head Email Address:
* Dept. Head Office Phone:
Dept. Head Fax:
PROJECT FOR GRANT / FUNDING INFORMATION:
*Descriptive Title of Project (be specific and descriptive):
*Estimate Project Funding Needed:	$ Required Format: Numbers Only (and optional decimal point), no comma's or dollar sign! xxxxx.xx \| i.e. 2400.99 or 400000
*Area(s) Affected by Project (select all that apply):	Other (please specify):
*Proposed Project Start Date:	Required Format: xxxx-xx-xx \| 4digit year - 2digit month - 2digit day. i.e. 2009-12-14
*Proposed Project End Date:	Required Format: xxxx-xx-xx \| 4digit year - 2digit month - 2digit day. i.e. 2009-12-14
*Congressional District of Applicant and Project (If different than above):
*Does Your State Require Review of the Project Application by Order 12372? (select one):
*Is Your Agency/Entity Delinquent of Any Federal Debt? (select one):
*Do You Know of Any Specific Grant Source Available That You Wish to Apply For?	Yes No
KNOWN GRANT / FUNDING SOURCE FOR PROJECT INFORMATION:
IMPORTANT NOTE: This section should ONLY be completed if you know of any specific grant/funding source currently available for your desired project.
Agency Administering Grant Name:
Potential Grant/Funding Source Name:
Agency Administering Grant Contact Information:
First Name:
Last Name:
Tile :
Email:
Office Phone:
Application Type (select one):
Catalog of Federal Domestic Assistance (CDFA) Name:
CFDA Number (from federal program listing):
CFDA Title/Type:
Is Other Funding Available? (select all that apply):	Other (please specify):