Iowa Department of Education Even Start

William F. Goodling Family Literacy Grant 2006-2007

Form A                                                                                                          Due: April 1, 2006

Agency/Program Name

 

 

U.S.Congressional District (circle one)

           1        2        3        4        5

Address

 

 

 

City

Zip Code

Employee Federal Tax

 Identification Number (FTIN)

 

 

Amount of Federal Grant

 Funds Requested

Amount of Local Share Provided

Application for: (check one)

 

o New Grant              or                         o Continuation Grant

                                                                                      o Requested for Years 4-8

                                                                                      o Requested for Years 9 and beyond

Total Grant (Fed + Local)

Estimated Number to be Served

    Children:                                       Families:

 

Telephone Number

FAX Number

 

E-Mail

 

 

Project Title (if applicable)

Geographic Area Served

(Counties or AEA)

 

 

Urban       o

 

Rural        o

 

School District Number

 

 

 

Brief Description of Proposed Project  (This description will be used to portray the project on the Department web pages.  Please do not exceed this space.)

 

 

 

 

 

 

 

 

To the best of my knowledge, all data in this application 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 project is selected for funding.

 

Name of Head Administrator:

Title:

Telephone:

 

 

Signature:

 

Date:

 

 

Mailing Instructions:

 

Please send the original and three (3) copies of this application to

 

 

Iowa Department of Education

Attn: Haila Huffman

Grimes State Office Building

Des Moines, Iowa 50319

 

The application and copies must be received at the Department by:

April 15, 2006.