Form Naa-01 - Connecticut Neighborhood Assistance Act (Naa) Program Proposal - 2012 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: ________________________________________________________
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)
Telephone number: ______________________________________________________________
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)
Fax number: ___________________________________________________________________
Email 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. 03/12)
Page 4 of 5
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