Form Naa-01 - Connecticut Neighborhood Assistance Act (Naa) Program Proposal - 2009 Page 2
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4Please check the appropriate description of your program:
______ 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; or
______ Other: Specify ____________________________________________________ .
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 (SSN): ____________________
2. Name: _______________________________________________________________________
Address: _____________________________________________________________________
_________________________________________________________________________
Duties and responsibilities: _______________________________________________________
_________________________________________________________________________
Connecticut Tax Registration Number or SSN: ________________________________________
Form NAA-01 (Rev. 02/09)
Page 2 of 5
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Parent category: Financial