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ARPA Community Grant Program Cover Sheet

  1. Nonprofit Organization Type (Check One and Include Determination Letter, 990 Filing, or other applicable IRS correspondence):*
  2. If you selected other, please select an option from the list below
  3. Eligibility Category: *

    Select all that apply.

    1. Response to the impacts of COVID-19 in one of two ways:
      1. Response to the public health emergency, and
      2. Response to the negative economic impacts related to the public health emergency,
    2. Provision of premium pay or grants to provide premium pay for essential workers, and
    3. Investment in water, sewer (including stormwater) or broadband infrastructure.
  4. I certify, to the best of my knowledge, that:
    1. The enclosed application is true and correct, and
    2. This Organization does not support or engage in any form of terrorist activity, and
    3. No funding awarded to this Organization will be distributed to or used to benefit any organization or individual supporting or engaged in terrorism, or used for any other unlawful purpose, and
    4. All funding awarded to this Organization will be used as intended for an eligible use permitted under the Rule, and
    5. I understand that this Organization is required to reimburse the City of Milford for any award determined by the City of Milford, the U.S. Treasury, the State of Delaware Auditor of Accounts or any other state or federal regulatory agency to be in violation of the permitted uses of ARPA funding under the Rule.
  5. Please type your full name & title

    1. Organizational Information
    2. Purpose of Funding
    3. Evaluation Plan
    1. Itemized Budget: Please download the template from the instructions webpage
    2. Budget Narrative (optional)
  6. Leave This Blank:

  7. This field is not part of the form submission.