Office of Representative Maurice D. Hinchey
Fiscal Year 2010 Appropriations Form

Please fill out this form and return it to your point of contact at Rep. Hinchey's office, via e-mail, by 
Friday, February 13, 2009.    

Date submitted:       

Name of submitting institution:       

Address of submitting institution:
	Street Address:       
	City:       	State:       	Zip:     

Project title:       
Project description: (Maximum of 250 characters)       
Amount of funding sought:        
What is the total cost of this project?       
Is this project included in the president's FY 2010 budget request? If so, at what level?      

Please detail how this money will be spent: (Maximum of 500 characters)       
Where will the work be completed?       

Under which bill do you seek funding? <choose>
Under which agency (within the above bill ) do you seek funding?       
Under which account (within the above agency) do you seek funding?      

Does the requesting institution expect to request additional funding for this project in future 
federal fiscal years?       

Is there report language attached to this project request? If so, include it here:      

Program manager/contact at the agency if you have one:      

Please list all earmarks this project received over the past five fiscal years:
	FY 2009:       
       FY 2008:       
	FY 2007:       
	FY 2006:       
	FY 2005:       

Please list all of the funding that you have received to date for this project, as well as the amount 
of work you have completed. (Maximum of 500 characters)
     

Most federal programs require a local match.  Please list all sources of funding that you anticipate 
will support the project, as well as the amounts anticipated from each source.  Please include all 
state, local, and private funding.  (Maximum of 500 characters)       

Describe your project, explain the benefit or impact of the project, and detail how the project 
meets the criteria of your proposed agency, bill and account.  Include information regarding job 
creation and economic impact.  (Maximum of 3500 characters - approximately one page)
     

Please discuss any other projects for which the institution is seeking federal funding in Fiscal Year 
2009.  Include a summary of each project, the amount(s) sought, the bill(s) and account(s) 
proposed for each project, and the names of the offices with whom you are consulting on each 
additional project. (Maximum of 1000 characters)
     

Please provide the following contact information:
*	Highest-level person at the institution (contact for Congressman Hinchey):
Name:  	      				Title:       
Address:  	      		
Office Phone:        			  Office Fax:       
Mobile Phone:       			          Email:       

*	Staff contact at the institution (For our Washington, D.C. staff):
Name:  	      				Title:       
Address:  	      		
Office Phone:        			  Office Fax:       
Mobile Phone:       			          Email:       

*	Lobbyist/government affairs contact (If you have one, not required):
Name:  	      				Title:       
Address:  	      		
Office Phone:        			  Office Fax:       
Mobile Phone:       			          Email:       

*	Contact information for every other House and Senate office contacted:
Member Name:      
Staffer Name:      
Email/Phone Number:      
Notes:      
Member Name:      
Staffer Name:      
Email/Phone Number:      
Notes:      
Member Name:      
Staffer Name:      
Email/Phone Number:      
Notes:      
Member Name:      
Staffer Name:      
Email/Phone Number:      
Notes:      

All requests for funding that Congressman Hinchey submits to the Appropriations Committee will 
be posted on his website in accordance with new Committee rules for the 111th Congress.
  
With project funding in appropriations bills coming under increased scrutiny, our office must 
double its efforts to ensure that funds are spent in the manner for which they are intended.  By 
initialing this sheet, your organization acknowledges that any funds received will be spent during 
Fiscal Year 2010, on the project described on this application.  Funds that are not spent in 
accordance with this requirement are subject to rescission by the Congressman and the 
Appropriations Committee.

Please type your name, position with the organization, and initials here: