PART I - FACE SHEET

APPLICATION FOR FEDERAL ASSISTANCE
Modified Standard Form424 (Rev.02/07 to confirm to the Corporation's eGrants System)
1. TYPE OF SUBMISSION:
Application X Non-construction
2a. DATE SUBMITTED TO CORPORATION FOR NATIONAL AND COMMUNITY SERVICE (CNCS):
08/09/11
2b. APPLICATION ID:
11CB131275
3. DATE RECEIVED BY STATE:
STATE APPLICATION IDENTIFIER:
4. DATE RECEIVED BY FEDERAL AGENCY:
08/09/11
FEDERAL IDENTIFIER:
11CBHCA001
5. APPLICATION INFORMATION
LEGAL NAME: Community Initiatives
DUNS NUMBER: 828767884
ADDRESS (give street address, city, state, zip code and county):
354 Pine St
Ste 700
San Francisco CA 94104 - 3229
County: San Francisco
NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS APPLICATION (give area codes):
NAME: Melanie Beene
TELEPHONE NUMBER: (415) 230-7710
FAX NUMBER: (415) 230-7701
INTERNET E-MAIL ADDRESS: melanie@communityin.org
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
943255070
7. TYPE OF APPLICANT:
7a. Non-Profit
7b. Service/Civic Organization
8. TYPE OF APPLICATION (Check appropriate box).
XNEW NEW/PREVIOUS GRANTEE
CONTINUATION AMENDMENT
If Amendment, enter appropriate letter(s) in box(es):
A. AUGMENTATION B. BUDGET REVISION
C. NOCOST EXTENSION D. OTHER (specify below):
9. NAME OF FEDERAL AGENCY:
Corporation for National and Community Service
10a. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 94.022
10b. TITLE: Nonprofit Capacity Building
11.a. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
Homeless Youth Capacity Building Project
11.b. CNCS PROGRAM INITIATIVE (IF ANY):
None
12. AREAS AFFECTED BY PROJECT (List Cities, Counties, States, etc):
Seven California Counties: Alameda, Fresno, Los Angeles, Riverside, San Bernardino, San Francisco, Santa Clara.
13. PROPOSED PROJECT: START DATE: 10/01/11 END DATE: 09/30/13
14. CONGRESSIONAL DISTRICT OF:   a.Applicant CA 12   b.Program CA 12
15. ESTIMATED FUNDING: Year #: 1
a. FEDERAL
$ 200,000.00
b. APPLICANT
$ 200,000.00
c. STATE
$ 0.00
d. LOCAL
$ 0.00
e. OTHER
$ 0.00
f. PROGRAM INCOME
$ 0.00
g. TOTAL
$ 400,000.00
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS?
YES. THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON:
DATE:
XNO. PROGRAM IS NOT COVERED BY E.O. 12372
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
YES if "Yes," attach an explanation. XNO
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a. TYPED NAME OF AUTHORIZED REPRESENTATIVE:
Melanie Beene
b. TITLE:
c. TELEPHONE NUMBER:
(415) 230-7710
d. SIGNATURE OF AUTHORIZED REPRESENTATIVE:
e. DATE SIGNED:
09/20/11