Office of U.S. Rep. Michael A. Arcuri (NY-24)
Fiscal Year 2010 Federal Appropriations Request Form


Name of Submitting Institution: 
Address:  	

Name of Entity to Receive Funds (if different from submitting institution):
Address:

Date Submitted:				

County: 

Project Title: 

Staff Contact Information at the Submitting Institution: (ALL fields required)
Name:
Address:
Office phone:
Cell phone:
Email:

Project Description (short description of how the money will be spent - two sentences):


Please also attach a one-paragraph description of the project, amount requested, and a full 
budget breakdown.  


Have you applied for a competitive federal grant or loan for this project?  (Opportunities 
available through http://www.grants.gov/)


Please list institutions/departments to which you have applied.  

Amount of funding requested for fiscal year 2010: 

Total Project Cost:	
				
Is the project included within the President's budget? 

Fiscal Year 2010 Appropriation Bill (if known):	
	
Program Title (if known):

Project's Authorization Authority (if applicable):

HISTORY (If you have previously received federal funding, please list the amount of money 
this project has received over the last five fiscal years): 

FY09:
FY08:
FY07:
FY06:				
FY05: 

Have you made the same request through any other federal Representatives or Senators? 
(If yes, please list names and contact information (including staff contact) below)			
	

Lobbyist/Government Affairs Representative (if applicable):
Name:
Address:
Email:					
Phone: 

Staff Contact in Rep. Arcuri's District Office (if applicable): 

Include a short description below of the submitting organization, business or local 
government (i.e. employment level, new jobs created through project request, etc...):


Please include at least three (3) letters of support for the project request from members of 
the community that will benefit from this project (i.e. local officials and/or not-for-profit 
agencies).


Also, include any additional information you may deem necessary with this form.  


Please email completed forms to Chris.Wilcox@mail.house.gov (please use Microsoft Word 
documents only - no PDF files)


Any questions on how to fill out this form should be directed to:

Christopher Wilcox
Legislative Counsel
U.S. Rep. Michael Arcuri (NY-24)
202-225-3665
Chris.Wilcox@mail.house.gov



***All fiscal year 2010 funding requests are due no later than COB February 13, 2009***