Standard Form 424 - Application For Federal Assistance

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Version 7/03
APPLICATION FOR
FEDERAL ASSISTANCE
2. DATE SUBMITTED
Applicant Identifier
1. TYPE OF SUBMISSION:
3. DATE RECEIVED BY STATE
State Application Identifier
Application
Pre-application
Federal Identifier
   Construction
   Construction
4. DATE RECEIVED BY FEDERAL AGENCY
   Non-Construction
   Non-Construction
5. APPLICANT INFORMATION
Legal Name:
Organizational Unit:
Department:
The Regents of New Mexico State University
College of Agriculture & Home Economics
Organizational DUNS:
Division:
17-385-1965
Address:
Name and telephone number of person to be contacted on matters
Street:
involving this application (give area code)
Office of Grants and Contracts, P.O. Box 30001, MSC OGC
Prefix:
First Name:
1620 Standley Drive, Academic Research Bldg., Room 110
Mr.
Tim
City:
Middle Name:
Las Cruces
County:
Last Name:
Dona Ana
Nesbitt
State:
Zip Code:
Suffix:
New Mexico
88003-8001
Country:
Email:
ritparra@nmsu.edu
United States
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
Phone Number:
Fax Number: (
(give area code)
give area code)
-
8
5
6
0
0
0
4
0
1
(505) 646-3376
(505) 646-2301
8. TYPE OF APPLICATION:
7. TYPE OF APPLICANT: (See back of form for Application Types)
New
Continuation
Revision
I. State Controlled Institution of Higher Learning
If Revision, enter, appropriate letter(s) in box(es)
(See back of form for description of letters.)
Other (specify)
9. NAME OF FEDERAL AGENCY:
Other (specify)
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:
11. DESCRIPTIVE TITLE OF APPLICANT’S PROJECT:
-
TITLE (Name of Program):
12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc.):
13. PROPOSED PROJECT
14. CONGRESSIONAL DISTRICTS OF:
Start Date:
Ending Date:
a. Applicant
b. Project
15. ESTIMATED FUNDING:
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
ORDER 12372 PROCESS?
a. Federal
$
THIS PREAPPLICATION/APPLICATION WAS MADE
a. Yes.
AVAILABLE TO THE STATE EXECUTIVE ORDER 12372
b. Applicant
$
PROCESS FOR REVIEW ON
c. State
$
DATE:
d. Local
$
PROGRAM IS NOT COVERED BY E. O. 12372
b. No.
e. Other
$
OR PROGRAM HAS NOT BEEN SELECTED BY STATE
FOR REVIEW
f. Program Income
$
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
g. TOTAL
$
Yes If “Yes” attach an explanation.
No
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT. THE
DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE
ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a. Authorized Representative
Prefix
First Name
Middle Name
Dr.
Robert
J.
Last Name
Suffix
Czerniak
b. Title
c. Telephone Number
(give area code)
Assistant Vice President of Grants and Contracts
(505) 646-1590
d. Signature of Authorized Representative
e. Date Signed
Previous Edition Usable
Standard Form 424 (Rev.9-2003)
Prescribed by OMB Circular A-102
Authorized for Local Reproduction

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