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Grant Information Form
1. Grantor:
2. Grant ID:
3. CFDA #, if applicable:
4. Grant Start Date:
5. Grant End Date:
6. Grant Amount:
7. Brief Description of Grant:
8. Grantor Contact Name:
9. Grantor Contact Phone:
10. Grantor Contact Email:
11. Grantor Contact Address:
12. Date Grant Application Submitted:
13. Date Grant Award Received:
14. Date Grant Award Accepted:
15. Date Grant Award Declined:
16. Report Requirements and Due Dates:
17. Is there a match requirement? Yes ☐ No ☐ If so, how much? :
18. Have the grant related expenses been budgeted for? Yes ☐ No ☐
19. Minority Impact Statement:
Census Tract Minority Population: Choose an item.
Summarize Positive/Negative Impacts:
If there is a negative impact, please explain the reason for proceeding with this grant:
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20. Grant Project Manager:
Updates to Grant
21. Date Grant Extension, Modification, etc. Requested:
22. Date Grant Extension, Modification, etc. Approved:
23. Brief Description of Grant Extension, Modification, etc.:
24. Date of Grant Modification made by the Grantor (not requested by the City):
25. Brief Description of the Grant Modification made by the Grantor: