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

Form Naa-01 - Connecticut Neighborhood Assistance Act (Naa) Program Proposal - 2003 Page 3

Total Number of Recipients

______________

Eligibility criteria for 60% Programs:

Check here if at least 75% of recipients (indicated above) are low income

persons who do not have an income exceeding 150% of the poverty level.

If job training and education programs, check all boxes that apply:

Program is directed at unemployed persons aged 50 or over;

Program is directed at disabled persons;

Program is directed at persons currently receiving Temporary Family

Assistance.

If energy conservation program, check all boxes that apply:

Property occupied by persons at least 75% of whom are at an income

level not exceeding 150% of the poverty level;

Property occupied by charitable corporation, foundation, or trust.

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: _____________________________________________________