Hon. Nita M. Lowey
Appropriations Funding Request Form
FISCAL YEAR 2010

1. ALL APPLICATIONS ARE DUE BY 5 PM ON JANUARY 21, 2009. 

	APPLICATIONS RECEIVED AFTER THIS DATE MAY NOT BE CONSIDERED FOR FUNDING. 

2. COMPLETED APPLICATIONS

	COMPLETED APPLICATIONS SUBMITTED VIA E-MAIL SHOULD BE SENT TO: 
	TAYLOR.PALMER@MAIL.HOUSE.GOV

IN THE SUBJECT LINE OF THE E-MAIL, PLEASE PUT YOUR ORGANZATION'S NAME FOLLOWED BY 
"FY10 APPROPRIATIONS REQUEST FORM".  EXAMPLE: ORGANIZATION X-FY10 
APPROPRIATIONS REQUEST

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THANK YOU FOR YOUR COOPERATION AND PATIENCE THROUGH THIS PROCESS.  PLEASE KNOW THAT 
WHILE THE APPROPRIATIONS PROCESS BEGINS EARLY IN THE YEAR, MANY OF THE BILLS THAT FUND 
PROJECTS WILL NOT BE CONSIDERED BY CONGRESS UNTIL THE END OF THE CALENDAR YEAR.  
THEREFORE, REQUEST(S) MAY NOT BE APPROVED UNTIL AS LATE AS DECEMBER 2009.  

IF YOU HAVE ANY QUESTIONS OR CONCERNS, PLEASE CONTACT MY GRANTS COORDINATOR, TAYLOR 
PALMER, OR MY DISTRICT DIRECTOR, PATRICIA KEEGAN, AT 914-428-1707. 

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PLEASE PROVIDE THE INFORMATION REQUESTED IN THE SPACE PROVIDED

APPLICATIONS NOT FULLY COMPLETED Will NOT BE CONSIDERED FOR FUNDING.


Name of Submitting Institution/Entity (municipality/institution/organization):      

Primary Contact (name, title, address, e-mail, phone, fax):
      

Secondary Contact (name, title, address, e-mail, phone, fax):
     

Project Statement of Purpose:       
(Please provide a brief description-no more than 2 sentences-of how funding will be used. 
Example: Funding will be used to develop an afterschool program). 

Project Summary:       
(Please provide a narrative of no more than 500 words describing the project, including background, 
need, and use of funding). 

Total Project Cost: $     

Amount being requested for this project in Fiscal Year 2010:$      


Budget Breakdown/Timeline of Use of Funds:      
(Example: salary $40,000; computer $3,000; renovations $10,000; etc.) 

Federal Appropriations Funding History for this Project (if applicable):

FY09 Appropriation: $     			FY08 Appropriation: $     

FY07 Appropriation: $     			FY06 Appropriation: $     

Have you submitted this request to any other Members of Congress or Senators?  If so, which 
one(s)?
     

Have you applied for State funding as well?      

Have you applied for competitive grants to fund this project?  If so, which one(s) and when?  
Were you successful?
     

Are State or local matching funds available if required? If so, how much?       
(Many projects have a cost-sharing requirement which can range between 20-45 percent. For instance, 
the FEMA Pre Disaster Mitigation Program, which funds hazard mitigation projects including storm water 
drainage, requires a 25% local match. Similarly, the EPA's State Tribal Assistance Grants (STAG), which 
funds water treatment and sewer projects, requires a 45% local match. This means that a $1 million 
project with a 45 percent match requirement 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. 

Priority # (ranked as compared to you other requests):      

Date submitted:      			

Form submitted by: 














 


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