Form Naa-01 - Connecticut Neighborhood Assistance Act (Naa) Program Proposal - 2003 Page 2

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Is your organization required to file federal Form 990 or 990EZ, Return of Organization
Exempt from Income Tax?
Yes
No
If yes, attach a copy of the first page of your most recent return.
If no, attach a copy of your determination letter from the U.S. Treasury Department,
Internal Revenue Service.
PART II — PROGRAM INFORMATION
Description of Program: __________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Need for Program: ______________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Goals of Program: ______________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Neighborhood Area to be Served: __________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Form NAA-01 (Rev. 3/03)
Page 2 of 5

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