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):
07/21/11
2b. APPLICATION ID:
12MK131004
3. DATE RECEIVED BY STATE:
STATE APPLICATION IDENTIFIER:
4. DATE RECEIVED BY FEDERAL AGENCY:
07/21/11
FEDERAL IDENTIFIER:
12MKADC002
5. APPLICATION INFORMATION
LEGAL NAME: Youth Service America
DUNS NUMBER: 177958105
ADDRESS (give street address, city, state, zip code and county):
1101 15th St. NW
Suite 200
Washington DC 20005
County: District of Columbia
NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS APPLICATION (give area codes):
NAME: Silvia Golombek
TELEPHONE NUMBER: (202) 296-2992 116
FAX NUMBER:
INTERNET E-MAIL ADDRESS: sgolombek@ysa.org
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
521500870
7. TYPE OF APPLICANT:
7a. National Non Profit
7b. Service/Civic Organization
National Non-Profit (Multi-State)
Volunteer Management 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: 94.007
10b. TITLE: Martin Luther King Day
11.a. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
Semester of Service: Families
11.b. CNCS PROGRAM INITIATIVE (IF ANY):
None
12. AREAS AFFECTED BY PROJECT (List Cities, Counties, States, etc):
25 selected communities targeted by sub-grantees selected on a competitive basis. Community-based organizations and schools nationwide are eligible to apply.
13. PROPOSED PROJECT: START DATE: 09/01/11 END DATE: 08/31/12
14. CONGRESSIONAL DISTRICT OF:   a.Applicant   b.Program DC 00
15. ESTIMATED FUNDING: Year #: 1
a. FEDERAL
$ 80,000.00
b. APPLICANT
$ 301,479.00
c. STATE
$ 0.00
d. LOCAL
$ 0.00
e. OTHER
$ 0.00
f. PROGRAM INCOME
$ 0.00
g. TOTAL
$ 381,479.00
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:
Silvia Golombek
b. TITLE:
c. TELEPHONE NUMBER:
(202) 296-2992 116
d. SIGNATURE OF AUTHORIZED REPRESENTATIVE:
e. DATE SIGNED:
07/21/11