Office of Congressman Tim Bishop
Fiscal Year 2010
Appropriations Request Form

INSTRUCTIONS:

1. ALL APPLICATIONS ARE DUE BY 5:00pm ON FRIDAY, FEBRUARY 20, 2009.

No exceptions will be made.  Applications received after this date may not be eligible for submission.  

2. ***DO NOT ALTER THIS FORM*** altered forms may not be considered.

3. ALL SUBMISSIONS MUST BE MADE VIA E-MAIL.

*	Please return the questionnaire as an attachment via e-mail.  If your organization does not have access to 
e-mail, arrangements must be made with my Office BEFORE the February 20th deadline. 
*	Please do not attempt to submit your application(s) by mail.   

4. NOTICE OF DISCLOSURE: 

*	In order to ensure an open and transparent process, please be advised that the requestor must agree to 
public disclosure of any request for appropriations, and related information provided in support of a 
request pursuant to the rules and guidelines for the U.S. House of Representatives and the House 
Committee on Appropriations.  Any and all information may be posted on the websites of the House 
Committee on Appropriations and the Office of Congressman Tim Bishop.

5. COMPLETED APPLICATIONS:
	 
*	Completed applications must be submitted via E-MAIL to: mark.copeland@mail.house.gov
*	In the subject line of your e-mail, please include your organization's name followed by FY2010 
Appropriations Request.  Example: Organization X - FY2010 Appropriations Request


Thank you for your cooperation and patience through this process.  Please know that while the appropriations 
process begins early in the year, the vast majority of bills will not be considered by congress until the end of the 
calendar year. 

If you have any questions or Concerns, please contact my Legislative Director, Mark Copeland at: 

       Mark Copeland
       Legislative Director
	Office of Congressman Tim Bishop
	306 Cannon House Office Building
	Washington, D.C. 20515
       (202) 225-3826
	mark.copeland@mail.house.gov





Appropriations Bill:   PICK ONE

* - The Agriculture and Homeland Security bills are not likely to provide funding for new projects in Fiscal Year 
2009. Please call (202)225-3826 if you plan on requesting a project in these bills.

# - Additional forms may need to be completed for the various subcommittees. 

@ - The Labor, Health and Human Services and Education bill, includes Institute of Museum and Library Services


Please provide the information requested in the space provided.

Name of Submitting Institution: 
Please use legal grantee name

     
Address of Submitting Institution: 
Please complete all fields

Street:      
City:      
County:      
State:   
Zip:      
Website:      
Contact Information for Highest Level 
Person - Who may  Congressman Bishop 
contact? Please complete all fields

Name:      
Title:     
Work Phone:      
Cell Phone:      
Email Address:      
 
Contact Information for Bishop Staff: 
Please complete all fields

Name:      
Title:     
Work Phone:      
Cell Phone:      
Email Address:      

Lobbyist/Government Affairs 
Representative for the Institution: 
If applicable please complete all fields


Name:      
Company:      
Title:     
Work Phone:      
Cell Phone:      
Email Address:      

If you have submitted this request to any 
other Members of Congress or Senators 
please list them here:

     



FUNDING INFORMATION

Applicable Federal Department or Agency:
Example: FHWA, HHS, EPA, DOE
not required
     
Account within Department or Agency:
not required
     
Total Project Cost:
This should be the gross cost for the project
     
All anticipated sources of funding for the 
project and the amount you expect to 
receive from each source. e.g. State, Local, 
Private
     
Amount that you have raised to date and 
the amount of work you have completed.
     
Amount being requested for the project in 
Fiscal Year 2010: 
     
Breakdown/budget of the amount being 
requested for this project in Fiscal Year 
2009: Example:  salary - $40,000; 
computers - $3,000; etc.
     
Federal Funding History: 
*	Has this project has received federal 
funding over the past four fiscal years?
*	Please list the specific amount 
*	What Member of Congress (House or 
Senate) secured the funding?
*	What Federal agency allocated the 
funding for the project? 
*	If this is a request for transportation 
funding, list any funding received in the 
2005 Transportation Reauthorization 
Bill (SAFETEA-LU).
FY2009:       
Member of Congress:      
Federal Agency:      

FY2008:      
Member of Congress:      
Federal Agency:      

FY2007:      
Member of Congress:      
Federal Agency:      

FY2006:      
Member of Congress:      
Federal Agency:      

SAFETEA-LU:      
Member of Congress:      
Federal Agency:      
Priority Ranking:
If your organization is submitting more than 
one funding request, please rank the priority 
of this project)
   of   



Is there a Federal cost-share requirement for this 
project? 
Many projects have a federal cost-sharing 
requirement, which can range between 20-50%.  For 
a project with a 45% cost-share requirement - a $1 
million project would receive a maximum of 
$550,000 from the Federal government and the 
remaining $450,000 would have to be paid for 
through a non-federal source.

Pick ONE

If yes, what percentage of the total request 
will be matched?      %

For Army Corps of Engineers projects, please specify if funding is requested for a New Study or Construction 
Start: Pick One   

Please provide the Authorization (P.L. # and Section):       
Example: WRDA 1986, P.L. 99-662, Section 501(a).

PROJECT DESCRIPTION

Statement of Purpose - 
*	Please provide a brief description of how requested funding will be used.  Limit to no more than 2 
sentences.  (Example: Funding will be used for curriculum development.):

     

Project Summary - 
*	Please provide a short narrative describing the project. Maximum of 225 words.  
*	Narratives with more than 225 words may not be considered
*	If additional information is necessary, please include, as a separate file, an addendum to your email, as well 
as your short narrative below:

     


Current Jobs (Please list the current number of employees at the organization):       

Jobs Created (If any, please list the approximate number of jobs requested funding would create at the 
organization):       
						             


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