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):
2b. APPLICATION ID:
11ES124396
3. DATE RECEIVED BY STATE:
12/17/10
STATE APPLICATION IDENTIFIER:
4. DATE RECEIVED BY FEDERAL AGENCY:
FEDERAL IDENTIFIER:
11ESHMI0010001
5. APPLICATION INFORMATION
LEGAL NAME: B - H - K - Child Development Board
DUNS NUMBER: 163972482
ADDRESS (give street address, city, state, zip code and county):
Attn: Michael Poma
700 Park Ave
Houghton MI 49931 - 2453
County: Houghton
NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS APPLICATION (give area codes):
NAME: Patrick Rozich
TELEPHONE NUMBER: (906) 487-6600 152
FAX NUMBER: (906) 482-7329
INTERNET E-MAIL ADDRESS: parozich@bhkfirst.org
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
382051352
7. TYPE OF APPLICANT:
7a. Non-Profit
7b. Community-Based Organization
Local Education Agency
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: 94.006
10b. TITLE: AmeriCorps Fixed Amount Grant (State)
11.a. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
Superior AmeriCorps
11.b. CNCS PROGRAM INITIATIVE (IF ANY):
12. AREAS AFFECTED BY PROJECT (List Cities, Counties, States, etc):
Baraga, Houghton, Keweenaw, Gogebic, Ontonagon, Iron and Dickinson counties in Michigan's Upper Peninsula
13. PROPOSED PROJECT: START DATE: 08/22/11 END DATE: 08/21/12
14. CONGRESSIONAL DISTRICT OF:   a.Applicant MI 01   b.Program MI 01
15. ESTIMATED FUNDING: Year #: 1
a. FEDERAL
$ 586,500.00
b. APPLICANT
$ 0.00
c. STATE
$ 0.00
d. LOCAL
$ 0.00
e. OTHER
$ 0.00
f. PROGRAM INCOME
$ 0.00
g. TOTAL
$ 586,500.00
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:
Patrick Rozich
b. TITLE:
c. TELEPHONE NUMBER:
(906) 487-6600 152
d. SIGNATURE OF AUTHORIZED REPRESENTATIVE:
e. DATE SIGNED:
12/17/10