Form Naa-01 - Connecticut Neighborhood Assistance Act (Naa) Program Proposal - 2004 Page 2
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4______ 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;
______ Other (specify)
Please check the appropriate description of your program:
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:
2. Name:
Address:
Duties and Responsibilities:
Connecticut Tax Registration Number or Social Security Number:
Form NAA-01 (Rev. 3/04)
Page 2 of 4
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Parent category: Financial