Part I – general




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MASSACHUSETTS DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

STANDARD CONTRACT FORM AND APPLICATION FOR PROGRAM GRANTS

PART I – GENERAL



A. APPLICANT:


District Code:















ADDRESS:




TELEPHONE: ( )






B. APPLICATION FOR PROGRAM FUNDING




FUND

CODE


PROGRAM NAME


PROJECT DURATION



AMOUNT

REQUESTED


FY2016


STATE – OTHER NON-COMPETITIVE GRANT

administered by the

SCHOOL FINANCE UNIT


FROM


TO



317

METCO

Upon Approval

06/30/2016



C. I CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS CORRECT AND COMPLETE; THAT THE APPLICANT AGENCY HAS AUTHORIZED ME, AS ITS REPRESENTATIVE, TO FILE THIS APPLICATION; AND THAT I UNDERSTAND THAT FOR ANY FUNDS RECEIVED THROUGH THIS APPLICATION THE AGENCY AGREES TO COMPLY WITH ALL APPLICABLE STATE AND FEDERAL GRANT REQUIREMENTS COVERING BOTH THE PROGRAMMATIC AND FISCAL ADMINISTRATION OF GRANT FUNDS.




AUTHORIZED SIGNATORY:


TITLE:


TYPED NAME:


DATE:




Mail the 317 METCO proposal listed on this signature page to:
HADLEY CABRAL

SCHOOL FINANCE
Massachusetts Department of Elementary and Secondary Education
75 Pleasant Street
Malden, MA 02148-4906

Mail two (2) sets of the proposal, each with an original signature of the superintendent

DO NOT WRITE BELOW THIS LINE







MASSACHUSETTS DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION USE ONLY



GRANTS MANAGEMENT


For the Department Authorized Signatory:


Date:


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