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):
01/18/17
2b. APPLICATION ID:
17ED191973
3. DATE RECEIVED BY STATE:
STATE APPLICATION IDENTIFIER:
4. DATE RECEIVED BY FEDERAL AGENCY:
01/18/17
FEDERAL IDENTIFIER:
17EDHTX001
5. APPLICATION INFORMATION
LEGAL NAME: American YouthWorks
DUNS NUMBER: 938127946
ADDRESS (give street address, city, state, zip code and county):
1901 E Ben White Blvd
Austin TX 78741 - 7840
County: Travis
NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS APPLICATION (give area codes):
NAME: Jody Karr
TELEPHONE NUMBER: (512) 983-9946
FAX NUMBER:
INTERNET E-MAIL ADDRESS: jkarr@americanyouthworks.org
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
742197942
7. TYPE OF APPLICANT:
7a. Non-Profit
7b. 21st CSC
Service/Civic Organization
Community-Based Organization
National Non-Profit (Multi-State)
Geographic Focus - Rural and Urban
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: 94.006
10b. TITLE: AmeriCorps Fixed Amount Grant
11.a. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
Service and Conservation Corps
11.b. CNCS PROGRAM INITIATIVE (IF ANY):
12. AREAS AFFECTED BY PROJECT (List Cities, Counties, States, etc):
Texas
Louisiana
Oklahoma
Arkansas
13. PROPOSED PROJECT: START DATE: 11/01/17 END DATE: 10/31/18
14. CONGRESSIONAL DISTRICT OF:   a.Applicant TX 35   b.Program TX 35
15. ESTIMATED FUNDING: Year #: 1
a. FEDERAL
$ 805,800.00
b. APPLICANT
$ 1,013,172.00
c. STATE
$ 0.00
d. LOCAL
$ 0.00
e. OTHER
$ 0.00
f. PROGRAM INCOME
$ 0.00
g. TOTAL
$ 1,818,972.00
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:
Erin C. Lehnen
b. TITLE:
c. TELEPHONE NUMBER:
d. SIGNATURE OF AUTHORIZED REPRESENTATIVE:
e. DATE SIGNED:
05/22/17