Form Naa-01 - Connecticut Neighborhood Assistance Act (Naa) Program Proposal - 2005 Page 4
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4PART IV — MUNICIPAL INFORMATION
To be completed by the municipal agency overseeing implementation of the program
Name of Municipal Agency Overseeing Implementation of the Program: _______________
_____________________________________________________________________
Mailing address: _________________________________________________________
_____________________________________________________________________
Name of Municipal Liaison: _________________________________________________
(
)
Telephone Number: _______________________________________________________
(
)
Fax Number: ____________________________________________________________
E-mail address: __________________________________________________________
Post-Project Review
Is a post-project review required for this proposal?
Yes
No
If “Yes,” date post-project review due:
____________________
Date
Form NAA-01 (Rev. 2/05)
Page 4 of 4
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