Representative Christopher J. Lee 
Appropriations Request Form
Fiscal Year 2010

1.	Organization submitting request: 


2.	If submitting more than one request, please indicate the priority number for this project:


3.	Name, title, address, phone number and email address for each of the following:

a. Highest-level person at Organization

	b. Staff contact at Organization

	c. Lobbyist / Government Affairs Representative for Organization (if applicable)


4.	Describe the organization's main activities, including whether it is a public, private or non-
profit entity:


5.	How many people are currently employed by the Organization?


6.	Appropriations Subcommittee(s) from which funding is requested:


7.	Account/Agency within the Subcommittee's jurisdiction from which funding is requested:


8.	If the project is authorized, please provide the legal authorization of the specific project.  If it 
is not authorized, please provide an explanation of how the project relates to the agency's 
authorized mission:


9.	Exact name and location of project, including county:


10.	Brief description of the activity or project for which funds are being requested:


11.	What is the significance of the project?  What measurable improvement or outcome will 
result from the project?


12.	What is the current status of the project?  What is the estimated completion date of the 
project?  


13.	Total project cost:


14.	Amount requested for fiscal year 2010:


15.	Breakdown of requested funding (equipment, construction, etc):


16.	How many, if any, jobs will be created due to this funding? How many, if any, jobs will be 
retained due to this funding? 


17.	Is the project included in the President's budget request?  If so, please specify amount and 
exact location within the budget request.


18.	Is the organization receiving funding for this project from any Federal agency?  If so, please 
include information on the amount of funds, the years received, and the name of the Federal 
agency and program providing the funding:


19.	Have you applied for a competitive grant (not appropriations) for this project through 
Congressman Lee's office?  If so, through what Federal agency?


20.	Are there other funding sources contributing to this project (state, local, or private)?  If so, 
what has each source contributed?


21.	Has this project received funding in previous appropriations bills?  If so, please list all 
previous funding, including bills, year(s) received, and amounts received:


22.	Are there state/local matching funds available for this project if necessary?  If so, how much 
state/local funding is available?


23.	If the project is not located within the 26th Congressional District, please describe the impact 
or connection to the District:


24.	If possible, please include support letters for the project from community leaders or local 
elected officials.


25.	Please list all Members of the House and Senate that are also receiving this request and 
include whether a House Member has been designated as the lead for the project request.



If you have questions or need assistance, call Kelly Dixon at (202) 225-5265

Please email completed forms to kelly.dixon@mail.house.gov

Deadline for submission - February 13, 2009
(Office Use Only)		Sub Code: _______________
		Date Received: ___________