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):
01/25/11
2b. APPLICATION ID:
11TN126058
3. DATE RECEIVED BY STATE:
STATE APPLICATION IDENTIFIER:
4. DATE RECEIVED BY FEDERAL AGENCY:
01/25/11
FEDERAL IDENTIFIER:
11TNHMT001
5. APPLICATION INFORMATION
LEGAL NAME: Blackfeet Tribe
DUNS NUMBER: 172612756
ADDRESS (give street address, city, state, zip code and county):
PO Box 2334
Browning MT 59417 - 2334
County: Glacier
NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS APPLICATION (give area codes):
NAME: Chancey C. Kittson
TELEPHONE NUMBER: (406) 338-5031
FAX NUMBER: (406) 338-7530
INTERNET E-MAIL ADDRESS: chancey@blackfeethousing.org
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
810212955
7. TYPE OF APPLICANT:
7a. Indian Tribe
7b. Tribal Government Entity
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 Indian Tribes
11.a. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
Blackfeet Housing AmeriCorps Planning Project
11.b. CNCS PROGRAM INITIATIVE (IF ANY):
12. AREAS AFFECTED BY PROJECT (List Cities, Counties, States, etc):
Blackfeet Indian Reservation, Browning, Heart Butte, East Glacier Park, Babb, Glacier County Mt.
13. PROPOSED PROJECT: START DATE: 07/01/11 END DATE: 06/30/12
14. CONGRESSIONAL DISTRICT OF:   a.Applicant MT 00   b.Program MT 00
15. ESTIMATED FUNDING: Year #: 1
a. FEDERAL
$ 50,000.00
b. APPLICANT
$ 21,605.00
c. STATE
$ 0.00
d. LOCAL
$ 0.00
e. OTHER
$ 0.00
f. PROGRAM INCOME
$ 0.00
g. TOTAL
$ 71,605.00
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:
Marilyn Parsons
b. TITLE:
c. TELEPHONE NUMBER:
(406) 338-2624
d. SIGNATURE OF AUTHORIZED REPRESENTATIVE:
e. DATE SIGNED:
05/10/11