Form Naa-01 - Connecticut Neighborhood Assistance Act (Naa) Program Proposal - 2008 Page 2
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5Please check the appropriate description of your program:
______ Job training/education for unemployed persons aged 50 or over;
______ Job training/education for disabled persons;
______ Program serving low-income persons;
______ Energy conservation;
______ Child care services; or
______ Other: Specify ________________________________________________ .
Part II — Program Information
Description of Program: _______________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Need for Program: ___________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Neighborhood Area to Be Served: _______________________________________________
_________________________________________________________________________
Total Number of Recipients: ____________________________________________________
Administration of Program:
Identify every person or organization involved in the implementation and administration of the program.
Use additional sheets if necessary.
1. Name: _________________________________________________________________
Address:________________________________________________________________
____________________________________________________________________
Duties and Responsibilities: _________________________________________________
____________________________________________________________________
Connecticut Tax Registration Number or Social Security Number (SSN): _______________
2. Name: _________________________________________________________________
Address: ________________________________________________________________
____________________________________________________________________
Duties and Responsibilities: _________________________________________________
____________________________________________________________________
Connecticut Tax Registration Number or SSN: ___________________________________
Form NAA-01 (Rev. 02/08)
Page 2 of 4
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