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):
09/09/14
2b. APPLICATION ID:
15SR165190
3. DATE RECEIVED BY STATE:
STATE APPLICATION IDENTIFIER:
4. DATE RECEIVED BY FEDERAL AGENCY:
09/09/14
FEDERAL IDENTIFIER:
15SRAMD008
5. APPLICATION INFORMATION
LEGAL NAME: Asian American Center of Frederick
DUNS NUMBER: 611193884
ADDRESS (give street address, city, state, zip code and county):
1080 W Patrick St
Ste 16
Frederick MD 21703 - 3971
County:
NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS APPLICATION (give area codes):
NAME: Carol Haag
TELEPHONE NUMBER: (717) 387-2125
FAX NUMBER:
INTERNET E-MAIL ADDRESS:
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
861140556
7. TYPE OF APPLICANT:
7a. Non-Profit
7b.
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: 94.002
10b. TITLE: Retired and Senior Volunteer Program
11.a. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
Asian American Center of Frederick
11.b. CNCS PROGRAM INITIATIVE (IF ANY):
12. AREAS AFFECTED BY PROJECT (List Cities, Counties, States, etc):
RSVP of Frederick County is s new application for this project. The areas affected would be Frederick County, Maryland. Municipalities within Frederick County
City of Frederick
City of Brunswick
Town of Emmitsburg
Town of Myersville
Town of Middletown
Town of Thurmont
Village of Rosemont
Town of Walkersville
...
13. PROPOSED PROJECT: START DATE: 07/01/15 END DATE: 06/30/18
14. CONGRESSIONAL DISTRICT OF:   a.Applicant MD 06   b.Program MD 06
15. ESTIMATED FUNDING: Year #: 1
a. FEDERAL
$ 117,445.00
b. APPLICANT
$ 12,443.00
c. STATE
$ 1,405.00
d. LOCAL
$ 3,728.00
e. OTHER
$ 5,070.00
f. PROGRAM INCOME
$ 2240.00
g. TOTAL
$ 129,888.00
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:
Elizabeth Chung
b. TITLE:
c. TELEPHONE NUMBER:
(301) 694-3355
d. SIGNATURE OF AUTHORIZED REPRESENTATIVE:
e. DATE SIGNED:
02/11/15