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mEmoRAnDum
hiDe C. W. Kirby, Chairman
To Board of County Commissioners Dace—__ July 24, 1989
COLORADO From Walter J. Speckman, Executive Director e/cr 1.
su,,,ac,. Head Start Supplemental Grant for Travel
Enclosed for Board approval is a Head Start Supplemental Grant for
travel .
The Weld County Division of Human Resources' Head Start Program is
applying for $1,021.80 for travel for one staff person to attend the
Social Service Institute.
/-
89C 699
r.
• __OMB Approval No.0348-0006
2. AP
ANTS a.NUMBER 3. 5 = a.NUMBER
FEDERAL ASSISTAN( D
APPLI- CA*AM
1. TYPE CATION 08CH0019/16 IpENTI-
OF ❑ NOTICE OF INTENT(OPTIONAL) DENTIDEINTI b.DATE FIER
NOTE To BE b. DATE -- ----
SUBMISSION(Mark op- 0 PREAPPLICATION Year month day
ASSIGNEDASSIGNED Year month day
pmpkte ri APPLICATION 1669 07 18 BY STATE 19
box) •
Leave
Blank -
4. LEGAL APPLICANT/RECIPIENT 5. EMPLOYER IDENTIFICATION NUMBER(EIN)
a.Applicant Name Weld County Division of Human Resources 84-6000813
b.Organization Unit . Weld County Head Start Program 6.
c.Street/P.O.Box . P.O. Box 1805 GRAM a. NUMBER 1113 1 ' I6 1 CIO I
d.City . Greeley e.County We l d
1.State Colorado g.ZIP code. 80632 (From GSA) MULTIPLE
h.Contact Person(Name Mr. Walter J. Speckman, Exec. Director b. TITLE Child Development
a Telephone Na.) • (303) 353-3816 Head Start __
7. TITLE OF APPLICANTS PROJECT (Use section IV of this form to provide a summary desayaon of the e. TYPE OF APPLICANT/RECIPIENT
o pro)ectJ ft b . wa'�a'.i.'._,dim.
Dimond
I% 1989 Head Start Supplemental Grant for Travel Coto "
D to e-a,
.tee Diet --
...+++ Enter appropriate knee DI
9. AREA OF PROJECT IMPACT(Noma of aim mwtkt states rte) 10.ESTIMATED NUMBER 11. TYPE OF ASSISTANCE
OF PERSONS BENEFfTING B—Suppkonsrusl mwe F—Clite
g Weld County 265 C—Lan Hainpus. pp;
-'-
m
12. 'PROPOSED FUNDING 113. CONGRESSIONAL DISTRICTS OF: 14. TYPE OF APPLICATION
) AJY.. c-r+..rm c-Awa.+.+o-.
1.021 .8n ' APPLICANT b. PROJECT s-^ < 0
a.FEDERAL S .W n ea
Ear appropriate infer n
b.APPLICANT 255.45 •oo 4 County-Wide 17.TYPE OF CHANGE(Fw,a or,«)
A—a e e oar. rye..(5pe455/:
c.STATE .00 15. PROJECT START 16. PROJECT a-Drat..Dorn
DATE DURATION C-*O eee onto,
,
d.LOCAL .00 Year month day • E-Ca ,
1989 31 01 12 Monms'
e.OTHER .001 t 6. DATE DUE TO Year month day PM"ri hrawYs/
I. Total S 1,277.25 .� FEDERAL AGENCY 19 _
19. FEDERAL-AGENCY TO RECEIVE REQUEST 20.EXISTING FEDERAL GRANT
Health &sssHuuuman Servj,GESc IDENTIFICATION NUMBER
a. ORGANIZATIONAL UNIT(IF APPROPRIATE) HEALTH -8, rt.PIWIthiTkATIVE CONTACT(IF K
Office of Human bevel opmentOSc�v4o F IHtIMAN 0 . •eF1 �'.FNT •
0SER�IICE5 08CH0019/16
c. ADDRESS 21. REMARKS ADDED
Region 8, Federal Building REGIONS, FEDERAL SU=LO!tG
1961 Stout St. Denver, CO 803941 STOUT STREET, DENVER, CO 8O294 [r�y
[1 Yes RI No
22. To the best of my knowledge and belief, a. YES.THIS NOTICE OF INTENT/PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE STATE
✓ THE data n this preapplicalion/application EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON:
S APPLICANT ere true and correct the document has
LL CERTIFIES been duty authorized by the governing DATE
C THAT- body of the applicant and the applicant
a will comply with the attached assurances b. NO,PROGRAM IS NOT COVERED BY E.O. 12372 O
1 it the assistance is approved. OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW U
4 i 23. a. TYPED NAME AND TITLE b. SIGNATURE
CERTIFYING C.W. Ki rby, Chairman
w SENTATIVE Weld County Board of Commissioners �� -c.
24. APPLICA- Year month day 25. FEDERAL APPLICATION IDENTIFICATION NUMBEfi 26. FEDE ALL GRANT IDENTIFICATION
TION
RECEIVED 19
27. ACTION TAKEN (28. FUNDING Year month day 30. Year month date
STARTING — i
O a. AWARDED 29. ACTION DATE► 19 DATE 19
O b. REJECTED
.00 31. CONTACT FOR ADDITIONAL INFORMA- 32'. Year month date
0 c. RETURNED FOR a. FEDERAL SENDING
< AMENDMENT b. APPLICANT TION(Name and telephone number) ENDING
19
zzEEE T, 0 d. RETURNED FORc STATE .00 33. REMARKS ADDED
!3:
E.O.12372 SUBMISSION
BY APPLICANT TO d. LOCAL .00
STATE
❑e. DEFERRED e. OTHER .00 •
�'
❑ I. WITHDRAWN I. TOTAL S .00 (n Yes n No
NSN 7540.01-008_8162 424-t03 STANDARD FORM 424 PAGE 1 (Rev.4-84)
PREVIOUS EDITION . Prescribed by OMB Circular 4-702
IS NOT SABLE 89O699
Supplemental Grant Application
Narrative
The Weld County Division of Human Resources Head Start Program
is applying for $1,021.80 for travel for an additional staff
person to attend the Social Service Institute.
890699
PART II OMB No 03480006
PROJECT APPROVAL INFORMATION
Item I. - —_---_-
• Does this assistance request require Name of Governing Body-.
State., local regional, or other priority rating? Priority Rating
Yes _No
Item 2.
Does this assistance request require State, or local Name of Agency or
advisory, educational or health clearances? Board
Yes No (Attach Documentation)
Item 3. L
Does this assistance request require State, local, Name of Aporoving, 9 ncy &O M!!?,?
regional or other planning approval? Date
Yes No
Item 4.
Is the proposed project covered by an approved compre- Check one: State ❑
hensive plan? Local ❑
Regional ❑
Yes No Location of Plan
Item 5.
Will the assistance requested serve a Federal Name of Federal Installation
installation? Yes No Federal Population benefiting from Project
Item 6.
Will the assistance requested be on Federal land or Name of Federal Installation
installation? Location of Federal Land
Yes .No Percent of Project
Item 7.
Will the assistance requested have an impact or effect See instructions for additional information to be
on the environment provided.
Yes No
Item 8. Number of:
Will the assistance requested cause the displacement Individuals
of individuals,families, businesses, or farms? Families
Businesses
Yes No Farms
Item 9.
Is there other related assistance on this project previous, See instructions for additional information to be
pending, or anticipated provided.
Yes No
890699
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