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

Form Naa-01 - Connecticut Neighborhood Assistance Act (Naa) Program Proposal - 2005 Page 3

Timetable:

Program Start Date: __________________________

Program Completion Date: _________________________

NOTE:

A certified post-project review is due to the municipality overseeing implementation no later than three

months after program completion date for all projects receiving $25,000 or more in NAA funding.

Month your annual accounting period ends: _____________

Method of accounting:

Cash

Accrual

PART III — FINANCIAL INFORMATION

Program Budget:

Complete in full.

Sources of Revenue:

NAA Funds Requested

__________________

Other Funding Sources (itemized sources):

__________________

Total Funding:

Proposed Program Expenditures:

Direct Operating Expenses (itemized description):

__________________

Administrative Expenses:

Professional Fund-raising Fees

__________________

Accounting/Legal & Other Expenses (itemized):

__________________

Total Proposed Expenditures:

Form NAA-01 (Rev. 2/05)

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Form Naa-01 - Connecticut Neighborhood Assistance Act (Naa) Program Proposal - 2005 Page 3