Section 950.330  Application

The Department shall provide a written application, instructions, and forms to potential or requesting applicants.  In addition to other items required in this Part, the Department shall request at least the following items in the application:

a)         The name, address, and telephone, facsimile, and teletypewriter numbers of the applicant.

b)         The name, address, and telephone, facsimile, and teletypewriter numbers of the entity through which the application is being submitted.

c)         A two-page non-technical abstract that describes the significance of the applicant's program concerning prostate or testicular cancer.

d)         The Social Security Number, Taxpayer Identification Number, or the Governmental Unit Code assigned by the State Comptroller.

e)         The signature of the agency official authorized to certify the application.

f)         A detailed budget for the funding period, documenting sufficient resources to carry out the program.  The budget shall be by line item category and shall provide sufficient detail to justify the use of grant funds to support program activities.

g)         An approximate timetable for completion of the entire program.

h)         A signed statement of assurances indicating compliance with applicable State and federal statute and regulations.