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NORTH CAROLINA LOCAL GOVERNMENT <br />APPLICATION FOR FFY 2007 FUNDING <br />INSTRUCTIONS FOR COMPLETING EM FORM 66 <br />1.1 EM Agency Name -Type or print the official legal title of the <br />Emergency Management (EM) agency. <br />1.2 Address, City, Zip Code -Type or print the address, city, and zip <br />code. <br />1.3 Date Completed -Type or print the date form was completed. <br />2.1 EM Program Director -Type or print the name of the local EM <br />Program Director and other EM staff by name and title. <br />NOTE: Must be the same title on the Position Description and <br />Organizational Chart. <br />2.2 Time % - EM Program Director will type or print the percent of time <br />they devote to Emergency Management program activities (e.g. <br />50%, 75%, 100%). <br />2.3 Current Salary -Type or print the current annual salary for each EM <br />program staff person. (Round to the nearest dollar). <br />2.4 Benefits -Type or print the annual benefits for the EM Program <br />Director to include social security, retirement, insurance and <br />unemployment. (Round to the nearest dollar). <br />2.5 Date Hired As. EM Program Director -Type or print the starting date <br />that the EM Program Director began work in this position. <br />Type or print the Other EM Staff by name and job title, their % time <br />with EM activities and current salary in the appropriate blocks. <br />2.6 Travel -Type or print the annual expenses for Transportation and <br />Subsistence (Meals and Hotels) as it pertains to the Emergency <br />Management personnel. (Round to the nearest dollar). <br />2.7 All Other -Type or print all other allowable annual operating <br />expenses which are required for day-to-day operations of the <br />emergency management office. (Round to the nearest dollar). <br />Rental - To include: <br />(Building or Space) -Rent of building or space occupied by <br />emergency management personnel. <br />5 <br />