Office of Representative Jerrold Nadler Appropriations Form 
Fiscal Year 2010

Please answer the following questions and return, preferably by e-mail, to the appropriate 
staff person in Congressman Nadler's office no later than Friday, February 27, 2009.  

Each organization is responsible for providing any additional information that the House 
Appropriations Committee may require.  Please note that all information submitted to 
Congressman Nadler's office regarding project requests may be made public.  

1.   Name of organization:

2.   Project title:

3.   Priority Number (if you are submitting more than one project):

4.   Amount Requested:

5.   Appropriation bill:

6.   Account within appropriation bill:

7.   Contact at organization:

	Name:
	Address:
	Phone Number:
	Fax Number:
	E-mail Address:

8.   Lobbyist/Government Affairs Representative, if applicable:

	Name:
	Address:
	Phone Number:
	Fax Number:
	E-mail Address:

9.   Name of highest level person at institution whom Congressman Nadler may contact 
directly:

	Name:
	Phone Number:

10.   Total cost of project:

11.   Other sources of funding for the project, including amounts already raised and anticipated                 
funding:


12.    Please provide a brief (five or six line) budget breakdown, describing the specific 
purposes for which funding will be spent (i.e.: renovations, training costs, computers, etc.):



13.   Has the institution ever received any kind of federal funding in the past? If yes, please specify 
the fiscal year, agency/account, and amount:



14.   Please provide a brief (one paragraph) description of your organization, its mission, and 
the work it does:



15.   Please provide a brief (one to two paragraph) description of the project and how your 
organization would use the requested federal funding.  Be sure to include any national impact 
or economic benefits the project would have. 



16.   Feel free to provide any additional relevant information you wish: