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Type of Funding Request (check all that apply): <br />Project <br />Program <br />Other (such as marketing, legal, professional services, grants or loans to companies for job <br />training) <br />Total Budget: <br />Amount of funding requested from EDRST: <br />Is this request anticipated to be a one-time request or multi-year? If multi-year, please provide <br />additional details, including anticipated future funding request, project details, and any other helpful <br />information. <br />Complete and attach form EDRST B-1 with budget cost summary. <br />I CERTIFY THAT ALL INFORMATION IN THIS APPLICATION IS TRUE AND COMPLETE TO THE <br />BEST OF MY KNOWLEDGE AND BELIEF. <br />_______________________________________________________________________________ <br />Name of Applicant Organization <br />_______________________________________________________________________________ <br />Authorized Signature Date <br />4 <br /> <br />