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APPLICATION SUBMITTAL CHECKLIST FOR OFFICE USE ONU <br />Received By <br />Agency Orange County Disability Awareness Council Date /Time <br />Complete Y / N <br />Program(s) _Education /Employment, Training, and <br />Technology Services <br />Section <br />1. Cover Page <br />Subsection <br />a. ❑ Applicant Contact Information <br />b. ❑ Project /Program Contact Information <br />c. ❑ Funding Requests Identified <br />d. ❑ Signed Application Cover Page <br />For CDBG & • <br />HUD Regulations <br />2. Agency <br />a. ❑ Agency's Years in operation <br />24 CFR 570.506, <br />Information - <br />b. ❑ Agency's Purpose /Mission <br />570.507, 570.610; 24 <br />c. ❑ Agency's Types of Services Provided <br />CFR Parts 84 or 85 <br />d. ❑ Agency's Experience <br />e. ❑ Other Pertinent Information <br />3. Program/ <br />a. ❑ Type of Application and Program Identified <br />24 CFR 570.200(a), <br />Project <br />b. ❑ Summary of Program <br />570.201 -570. 208, <br />Information - <br />c. ❑ Description of Identified Need <br />507.503 <br />(for each <br />d. ❑ Description of Population to be Served <br />program/ <br />e. F1 Activity Manager and Location Description <br />project for <br />which funding <br />f. F1 Activity Implementation Timeline <br />is requested) <br />g F-1 Agency Collaboration <br />h. ❑ Describe Impact of Reduced /No Allocation <br />i. ❑ Other Pertinent Information <br />j. ❑ Complete Target Population /Beneficiary Chart <br />k. ❑ Complete Schedule of Positions <br />I. ❑ Signed Conflict of Interest Disclosure <br />m. ❑ Complete Work Statement <br />i I P a g e <br />