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):
11/03/15
2b. APPLICATION ID:
16SR178175
3. DATE RECEIVED BY STATE:
STATE APPLICATION IDENTIFIER:
4. DATE RECEIVED BY FEDERAL AGENCY:
11/03/15
FEDERAL IDENTIFIER:
16SRSGA001
5. APPLICATION INFORMATION
LEGAL NAME: Athens Community Council on Aging
DUNS NUMBER: 75922252
ADDRESS (give street address, city, state, zip code and county):
135 Hoyt St
Athens GA 30601 - 2646
County: Clarke
NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS APPLICATION (give area codes):
NAME: David Lorren
TELEPHONE NUMBER: (706) 549-4850
FAX NUMBER: (706) 549-7786
INTERNET E-MAIL ADDRESS: dlorren@accaging.org
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
580977680
7. TYPE OF APPLICANT:
7a. Non-Profit
7b. Community-Based 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: 94.002
10b. TITLE: Retired and Senior Volunteer Program
11.a. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
Athens Community Council on Aging RSVP
11.b. CNCS PROGRAM INITIATIVE (IF ANY):
12. AREAS AFFECTED BY PROJECT (List Cities, Counties, States, etc):
Barrow County, Clarke County, Elbert County, Greene County, Jackson County, Jasper County, Madison County, Morgan County, Newton County, Oglethorpe County, and Walton County
13. PROPOSED PROJECT: START DATE: 04/01/16 END DATE: 03/31/19
14. CONGRESSIONAL DISTRICT OF:   a.Applicant GA 10   b.Program GA 10
15. ESTIMATED FUNDING: Year #: 1
a. FEDERAL
$ 49,049.00
b. APPLICANT
$ 22,795.00
c. STATE
$ 0.00
d. LOCAL
$ 22,795.00
e. OTHER
$ 0.00
f. PROGRAM INCOME
$ 0.00
g. TOTAL
$ 71,844.00
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:
Jennie Deese
b. TITLE:
Executive Director
c. TELEPHONE NUMBER:
(706) 549-4850
d. SIGNATURE OF AUTHORIZED REPRESENTATIVE:
e. DATE SIGNED:
11/03/15