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State Single Point of Contact (SPOC)

Type of Applicant
(Required*)
Type of Applicant:*	DC Government Agency Non-DC Government Agency
Proposal Deadline Date:*	Month Month January February March April May June July August September October November December Day Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year Year 2012 2013 2014 2015 2016 2017 2018
Organization Information
Legal Name of Organization:*
Organizational Unit:
DC Agency:*	Please Select a DC Agency Aging, Office on Advisory Commission on Sentencing Advisory Neighborhood Commissions, Office of African Affairs, Office of Alcoholic Beverage Regulation Administration Appeals and Review, Board of Arts and Humanities, Commission on the Asian and Pacific Islander Affairs, Office on Attorney General, Office of the Auditor, Office of the DC Boards and Commissions, Mayor's Office of Business Resource Center Cable Television and Telecommunications, Office of Campaign Finance, Office of Chief Financial Officer, Office of the Chief Medical Examiner, Office of the Chief of Staff, Office of the Chief Technology Officer, Office of the Child and Family Services Agency Citizen Complaint Review, Office of City Administrator, Office of the Citywide Call Center, Mayor's Communications, Executive Office of Community and Religious Affairs, Office of Consumer and Regulatory Affairs, Department of Contract Appeals Board Contracting and Procurement, Office of Corrections, Department of Council of the District of Columbia Court of Appeals, DC Criminal Justice Coordinating Council Department of Small and Local Business Development Disabilities Services, Department on Education, Office of the Deputy Mayor for Elections and Ethics, Board of Employee Appeals, Office of Employment Services, Department of Environment, District Department of the Ex-Offender Affairs, Office of Finance and Resource Management, Office of Fire and Emergency Medical Services Department Health Care Finance, Department of Health, Department of Historic Preservation Office Homeland Security and Emergency Management Agency Housing and Community Development, Department of Human Rights, Office of Human Services, Department of Inspector General, Office of the Insurance, Securities, and Banking, Department of Judicial Disabilities and Tenure, Commission on Judicial Nomination Commission Justice Grants Administration Labor Management Programs, Office of Labor Relations and Collective Bargaining, Office of Latino Affairs, Office on Local Business Development, Office of Lottery and Charitable Games Control Board, DC Mayor, Executive Office of the Mental Health, Department of Metropolitan Police Department Metropolitan Washington Council of Governments Motion Picture and Television Development, Office of Motor Vehicles, Department of National Capital Planning Commission Office of Disability Rights Parks and Recreation, Department of Partnerships and Grant Services, Office of People's Counsel, Office of the Personnel, Office of Planning and Economic Development, Office of the Deputy Mayor for Planning, Office of Police and Firefighters' Retirement Board Policy and Legislative Affairs, Office of Pretrial Services Agency Property Management, Office of Dept of Real Estate Services Public Charter School Board, DC Public Employee Relations Board Public Library, DC Public Schools, DC Public Service Commission Public Works, Department of Real Property Assessments and Appeals, Board of Retirement Board, DC Secretary, Office of the Serve DC Sports and Entertainment Commission State Superintendent of Education, Office of the Statehood Commission, DC Superior Court of the District of Columbia Tax and Revenue, Office of Taxicab Commission, DC Transit Authority, Washington Metropolitan Area Transportation, District Department of University of the District of Columbia Veterans Affairs, Office of Victim Services, Office of Washington Convention Center Authority Water and Sewer Authority, DC Women's Policy and Initiatives, Office on Workforce Investment Council, DC Youth Rehabilitation Services, Department of Zoning, Office of
DC Sub Agency:*	Please Select a DC Agency Division - NONE - AHPP-Administration for HIV Policy and Programs APRA - Addiction Prevention and Recorvery Administration Arts and Technology Academy Center for Policy, Planning and Epidemiology Community Health Administration DC Medical Examiner Office Early Childhood Education ECEA-Early Care and Education Administration EHA - Environmental Health Administration Emergency Management Agency Energy Division FSA - Family Service Administration Health Emergency Preparedness and Response Administration Health Regulation and Licensing Administration Health/ HIV/AIDS, Hepatitis, STD & TB Administration HPO-DC Historic Preservation Office IMA - Income Maintenance Administration JGA - Justice Grants Administration LEA-Local Education Agency Maternal and Primary Care Administration Medical Assistance Administration MFHA-Maternal and Family Health Administration Office of the Director OFGP - Office of Federal Grants Programs OGM - Office of Grants Management OHS-Office of Homeland Security OPLA-Office of Policy and Legislative Affairs OPYS - Office of Prevention and Youth Services OVS - Office of Victim Services PCPA - Primary Care and Prevention Administration RCSD - Residential and Community Services Division Rehabilitation Services Administration Restore DC WPD-Watershed Protection Division WVSA Arts Connection
Street Address:*
City:*
State:*	Please Select a State ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUSIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING
Zip:*
Dun & Bradstreet Number:*
Organization's Ward Location:	Please Select a Ward Location None Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Ward 8 Citywide

Authorized Person Representing Applicant (person completing this form)
Contact Name:*
Phone:	() -
Email:*
Application Information
Select Application Type:*	Please Select Application Type RENEWAL NEW CONTINUATION
Federal Agency:*	Please Select a Federal Agency Agency for International Development Appalachian Regional Commission Centers for Disease Control and Prevention Corporation for National and Community Service Department of Agriculture Department of Commerce Department of Defense Department of Education Department of Energy Department of Health and Human Services Department of Homeland Security Department of Housing and Urban Development Department of Interior Department of Justice Department of Labor Department of State Department of the Air Force Department of the Army Department of the Treasury Department of Transportation Department of Veterans' Affairs Environmental Protection Agency Federal Emergency Management Agency General Services Administration Institute of Museum and Library Services Internal Revenue Services National Aeronautics and Space Administration National Archives and Records Administration National Council on Disabilities National Endowment for the Arts National Endowment for the Humanities National Science Foundation Small Business Administration Social Security Administration The NEA Foundation United States Navy US Election Assistance Commision White House Office of National Drug Control Policy
CFDA#:*	. . (12.345 or 12.345.ab) CFDA
Grant Title:*
Descriptive Title of Applicant's Project:
Area of Services
Areas Affected by Project:*	Please Select Area Affected by Project WASHINGTON, DC AND OTHER WASHINGTON, DC OTHER ONLY
Geographical Service Area:*	WARD-1 WARD-2 WARD-3 WARD-4 WARD-5 WARD-6 WARD-7 WARD-8 NONE CITYWIDE
Mayor's Priority:*	Select Mayor's Priority Economic Development Education Environment Healthcare Jobs/Housing Public Safety Service
Priority:*	Please Select Priority Economic Development Education Healthcare Jobs/Housing Public Safety Service

Estimated Funding (Example: 120,000)
Federal:*		Applicant:
State:		Local:
Other:		Program Income:
Executive Summary
Executive Summary:*
Acknowledgement
* To the best of my knowledge and belief, all data in this application/pre-application are true and correct.  The document has been duly authorized by the governing body of the applicant and the applicant will comply with the attached assurance if the assistance is awarded.
	I Agree    I Do Not Agree
Name of Authorized Representative:*
Title:
Phone:	() -
Note: Office of the City Administrator reserves the right to request a copy of the full proposal.

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