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12 <br /> ESGP Round 4 Application Check List <br /> Name of Local Government (applicant): County of Orange <br /> Name of Subrecipient: Inter-Faith Counci ommuni y e er <br /> x 1. Do you have one original and one copy of the following <br /> forms for each Shelter? <br /> x a. Application Summary Form <br /> x b. Community Needs Form <br /> • <br /> c. One six page Operations/Services Activities Form <br /> OR <br /> x d. One four-page Rehabilitation Activities Form or both. <br /> _ X e. Certification Form <br /> X_ f. If applicable, is the comment letter from the Division <br /> of Archives and History enclosed? <br /> 2. Is the original application signed in ink by the local government. <br /> Chief Elected Officer on the Applications Summary Form and on the <br /> Certification Form? (Signature must match typed name) <br /> x 3. Are all questions of the application package answered completely? <br /> x 4. Will all application materials be received by the -Division of <br /> Community Assistance on March 28, 1989, or be postmarked by this date? <br /> N/A 5. If applicable, will both the Certification Form, ESGP #104 and the <br /> signature on the Application Summary Form, ESGP #101 be received or <br /> postmarked on or before April 11, 1989? <br /> March 211 1989 <br /> Signature Data <br /> Local Government Contact Person <br /> (Should be same as on Application Summary Form) <br /> • <br /> II . <br />