Application Form -PREVIEW

Colorado Division of Criminal Justice
Office of Adult and Juvenile Justice Assistance
Coronavirus Emergency Supplemental Funding Program (CESF)

CLOSED Deadline 9/1/2020

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Summary Organizational Details Period & Project Details Tables (Goals & Outcomes, Budget Details) Documents

Financial Report: OVERDUE Report Totals

Summary

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Project Name/Project Title
Amount Requested Application Initial Amount Requested	$

Applicant Information
First Name
Last Name
Telephone
Email

Organization Information

(changes to this data will be reflected on all other applications for this organization)

Applicant Agency Name

Address 1

Address 2

City

State/Province

ZIP+4/Postal Code

Country

Telephone

Fax (optional)

Website (optional)

Federal Tax ID (EIN) (XX-XXXXXXX)

UEI Number

IRS Verification

No current exempt IRS record was found for IDN . (Due to the IRS data sharing policy, ZoomGrants is unable to verify your IRS information. This does not mean the information is invalid. You can continue to submit your application as the system will repeatedly verify your information).
You might try searching the list of organizations whose federal tax exemption was automatically revoked located at the IRS Select Check Site

EIN:
Name:
ICO:
Street:
City:
State:
ZIP:
Subsection/Classification:	/ :
Affiliation Code:	:
Ruling Date:
Deductibility:	:
Foundation:	:
Organization:	:
Status:
Tax Period:
Asset Code:	:
Income Code:	:
Filing Requirement Code:	:
PF Filing Requirement Code:	:
Accounting Period:	:
Asset Amount:
Income Amount:
Revenue Amount:
National Taxonomy of Exempt Entities (NTEE) Code:	:
Sort Name (Secondary Name Line) :
Last Verified Date:

CEO/Executive Director (if NA, enter Signature Authority)

First Name

Last Name

Title

Organizational Details

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1. Legal Entity Name
Enter the Legal Entity Name here. If your agency is a DBA, the Legal name will be different than the Applicant Name. If your agency is NOT a DBA, then the Applicant Name and Legal Entity Name will be the same.

2. Legal Entity Physical Address
Enter the Legal Entity Street Address, City, State, Zip + 4 (e.g. 700 Kipling Street, Suite 1000, Lakewood, CO 80215-8957)

3. Are you a Colorado State Agency?
(e.g. Colorado Department of Revenue, Colorado Department of Corrections, Colorado Department of Public Safety, etc.)

4. Legal Entity County
Enter the County of your legal entity address

Submit Organizational Details

Period & Project Details

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Project Duration

1. Project Start Date
MM/DD/YYYY - The project period is eligible to backdate and start as of January 20, 2020 and can operate for two years (24 months).

2. Project End Date
MM/DD/YYYY - The project period is eligible to backdate and start as of January 20, 2020 and can operate for two years (24 months).

3. Please select the best option below:
(This response will show or hide subsequent questions)

	State of Colorado Government
	Local Government within Colorado
	Other (non-governmental)
	DCJ Administrator (Staff Only)

Project Officials

4. Application Primary Contact: Name
This is the individual that will be contacted during the review period, and will be notified of award decisions and next steps.

5. Application Primary Contact: Phone
This is the individual that will be contacted during the review period, and will be notified of award decisions and next steps.

6. Application Primary Contact: Email address
This is the individual that will be contacted during the review period, and will be notified of award decisions and next steps.

7. Project Director: Name
Enter salutation, first, last, title, agency (e.g. Mrs. Sally Smith, Program Coordinator, ABC Company)

8. Project Director: Mailing Address
Street Address, City, State, Zip + 4 (e.g. 700 Kipling Street, Suite 1000, Lakewood, CO 80215-8957)

9. Project Director: Email Address

10. Project Director: Phone Number

11. Financial Officer: Name
Enter salutation, first, last, title, Agency (e.g. Mr. John Doe, Senior Accountant, ABC Accounting Services)

12. Financial Officer: Mailing Address
Street Address, City, State, Zip + 4 (e.g. 700 Kipling Street, Suite 1000, Lakewood, CO 80215-8957)

13. Financial Officer: Email Address

14. Financial Officer: Phone Number

15. Signature Authority: Name
Enter salutation, first, last, title, agency (e.g. Ms. Jane Austen, County Commissioner Chair, ABC Company).

16. Signature Authority: Mailing Address
Street Address, City, State, Zip + 4 (e.g. 700 Kipling Street, Suite 1000, Lakewood, CO 80215-8957

17. Signature Authority: Email Address

18. Signature Authority: Phone Number

19. Project Summary
Provide a concise description of your project, include your goals, how they will be measured,

Tables (Goals & Outcomes, Budget Details)

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Goals & Outcomes

Goals & Outcomes: These are the elements against which the project will be evaluated and which will be used to report quarterly and final progress. Using the format below; provide project/program goal(s), outcome(s), measurement(s) and timeframe(s). See instructions for further information.


Goal(s)
Outcome(s)
Measurement(s)
Timeframe(s)
Total

Personnel: Budget & Budget Narrative Details

Each position must be listed separately and be accompanied by a description that provides justification for the amount requested and details the basis for determining the cost of each position. For each position, explain how the salary and fringe benefit rates were determined. See instructions for further information.
OT = Overtime

Personnel	Position Title and Name	Annual Base Salary	Annual Base Salary To Be Paid By Grant Funds	% To Be Paid By Grant Funds	Annual Fringe	Annual Fringe To Be Paid By Grant Funds	% To Be Paid By Grant Funds	Total Annual Base Salary + Fringe	Total Base Salary + Fringe To Be Paid By Grant Funds	OT - Annual Base Salary	OT - Annual Base Salary To Be Paid By Grant Funds	OT - Annual Fringe	OT - Annual Fringe To Be Paid By Grant Funds	Total To Be Paid By Grant Funds (including overtime)	Budget Narrative and Justification
1		$	$		$	$		$	$	$	$	$	$	$
2		$	$		$	$		$	$	$	$	$	$	$
3		$	$		$	$		$	$	$	$	$	$	$
4		$	$		$	$		$	$	$	$	$	$	$
5		$	$		$	$		$	$	$	$	$	$	$
6		$	$		$	$		$	$	$	$	$	$	$
7		$	$		$	$		$	$	$	$	$	$	$
8		$	$		$	$		$	$	$	$	$	$	$
9		$	$		$	$		$	$	$	$	$	$	$
10		$	$		$	$		$	$	$	$	$	$	$
Total		$ 0	$ 0	%	$ 0	$ 0	%	$0	$0	$ 0	$ 0	$ 0	$ 0	$0

Non-Personnel: Budget & Budget Narrative Details

Each item must be listed and be accompanied by a description that provides justification for the budget items and details the basis for determining the cost of each item. See instructions for further information.

Budget Item	Item	Amount To Be Paid By Grant Funds	Budget Narrative and Justification
SUPPLIES & OPERATING
S&O 1		$
S&O 2		$
S&O 3		$
S&O 4		$
S&O 5		$
S&O 6		$
S&O 7		$
S&O 8		$
S&O 9		$
S&O 10		$
Supplies & Operating Total		$0

TRAVEL
T 1		$
T 2		$
T 3		$
T 4		$
T 5		$
T 6		$
T 7		$
T 8		$
T 9		$
T 10		$
Travel Total		$0

EQUIPMENT
E 1		$
E 2		$
E 3		$
E 4		$
E 5		$
E 6		$
E 7		$
E 8		$
E 9		$
E 10		$
Equipment Total		$0

CONSULTANTS/CONTRACTS (PROFESSIONAL SERVICES)
CC 1		$
CC 2		$
CC 3		$
CC 4		$
CC 5		$
CC 6		$
CC 7		$
CC 8		$
CC 9		$
CC 10		$
Consultants/Contracts Total		$0
INDIRECT
I 1		$
Indirect Total		$0
Total		$ 0

Other CESF Funding for this project

If you will be/are receiving other CESF funding, complete the table listing each anticipated and/or received CESF grant award (provide the grant number, the amount of federal funds awarded, the project title, purpose area and grant period).

Other federal funding	CESF Grant Award Number	Amount of federal funds awarded	Project title	Purpose	Grant Period
Other CESF Funding for this project
CESF funding #1		$
CESF funding #2		$
CESF funding #3		$
CESF funding #4		$
CESF funding #5		$
		$
Total	0	$ 0.00

Other Emergency Funding for this Project

Other Emergency Funding (Enter 0 if you do not have other funding)

	Amount Awarded	Grant Number	Project Title	Purpose Area	Grant Period
Other Emergency Funding for this project (Enter 0, if there is no other funding)
1.	$
2.	$
3.	$
Total	$ 0.00

Ask a Report Question

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Report 1: 10/15/2020 Report 2: 10/15/2020 Report 3: 1/15/2021 Report 4: 1/15/2021 Report 5: 4/15/2021 Report 6: 4/15/2021 Report 7: 7/15/2021 Report 8: 7/15/2021 Report 9: 10/15/2021 Report 10: 10/15/2021 Report 11: 1/15/2022 Report 12: 1/15/2022 Report 13: 4/15/2022 Report 14: 4/15/2022 Report 15: 7/15/2022 Report 16: 7/15/2022 Report 17: 10/15/2022 Report 18: 10/15/2022 Report 19: 1/15/2023 Report 20: 1/15/2023 Report 21: 4/15/2023 Report 22: 4/15/2023 Report 23: 7/15/2023 Report 24: 7/15/2023

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