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assis:anve ac:rvir . i :. livable. S:ata intergovernmenta n=_+.ie~~~ prccess _~*.:he <br /> f. Name and contact inforrnatian of person to 6e canta~vted an apprW-«p+riats bcx. I' `a.' s se ~cte:i, enter :he not. the <br /> matters involving this application E.^:er t~^_ name (Frst and last: name app ,avian ~r+as subn•;i[:ed tc t^+ '*.r~t= <br /> -eawred; c~•~~anizaticn~ a~i~lition iif affiliated ti~+ith an c•~jani~a:ion at^?r <br /> than tr_ apa can: ~rganizaticn j.:elepnone n,imber «:Reauired; iax ~'tl. Js the Applicant Delinquent an any Fetleral Debt? <br /> rurr,~, and era! add _ss {-:equire~:j c~-':he persc~n:o con,.<c: an i=;etluiredy Seie~_ttre a~~wrapna._ ~ ~s: This Guest+vn a:.eiies t: <br /> n~atr:~s relatd:0'1115 .a:~fia;icn :i-~e a;~p6ca.^z argani~.t~:~n. net the ;._rsc^ ~x•hv+signs as :he <br /> au:hvr~ed r_pressnta r;t. r~ategc• _s .f :Ieb: include <br /> del--~.cuenk audit ~.i=_a c~r+anves. 6can=_ and texes. <br /> f ~•es, invJUde an _:a ~a^a:ivn cn th_ curt ^..aticn s^e-t. <br />2. Type o' A~•c~ can:: «;P,eauired} 21. Ausharized Representative: =eau ~rr_d'~ T o c•e signed anal <br /> 'elec. ,,p to :hre= appiECant:yp„s; in 3+.c~r;,ante tivitr agr4,y dated t+y t~ _ au:hcr~ed represernative ci :I7e avplivart <br /> ns:n«vticns. vng ;^ za:ion. Enter the name ;First and lass ^a^,. requ :•ac <br /> 5tat_ 3c•aernment M. N+c~nprof: vn:h `+~1C31RS *.rile iRequired;..:eleph~:~^ number (R_quiredi 'a:< n~.iml7er <br /> ~`uunty Govemn^=Ent St"atUS ; :'ther t'tan In517'UCC+^. and 21t'~~II u;.~re55 EReC'~«rE~l ^-~f ih~a pefSCn aLtt^._riZEC t~ Sizln <br /> C.it,+ tir To~~~a^shi~, Gci~ernment of 'r'igher Eduvavia^; `or :I7e .;pplivar~t.. <br /> '~ Sr~,:ial Cs:nct v+3vemrnen: h'. N~vnprof: tivi:hau.. t v3 IRS A cc•:;y of t^+e gcvemrng body's au:horr_atc~r. =or yvu tc sign <br /> - Regicnai C+rgan::a:ian Status ;Sihe•tran Institut+.~ ;!-us appiicatan as the vr«cidl • ire=__^:a,iv~ n°,us: t cn f e ~n <br /> .. -~rr•ory cr Pcssessian of ,-ipher Educ3tia^. ~ the a~•pli:-a,^t's cffce. ,Certain Federa ag :^+:ies ~riay rec.i.*e <br /> ndepenc~nt Svr.+~I L«is:rivt ~~. Pri+W~ate I s:it.s:ion of H gher that t^i_ xut^ariza:icn be submiCed as par, =i the app _atlon.; <br /> H~ _..~~ c,5ta:e «~v*trcliec Educat;,r, <br /> r,s:it~tivr os--igherEcluvahc~ P i~+i~i~,al <br /> ndian;hJa:i',eAmericanTriba ~a. F+r-Profi+'~,rganl~at+:V" <br /> Gc•aemmen:~,=ederary if3ther:hanSrc,all?.siness <br /> =tea. gn¢~: « -.. ;rc,ail ?.,sin _ ss <br /> ~I ndian,tJa:iu•e Amehcan Triba >ry. Hspa~*.._-ser; a-g nsci:utic+^ <br /> Gavemmens ~;Ct:her than, T. H storivaliy E•lavk Ca egos <br /> =ederaliy Rec.gni~edi and Ur •uersit:_s HSvUs', <br /> ndian.tJa:ive An7ehvan .,. Trbaliy Cant,^,~ Ie;I C:clleges <br /> Tribalhr C~esgnated and U:^•uersites i-CCUs;« <br /> ~,-,area;ion ti~". lila5ka Native and Patve <br /> _. '..~ cand an -,ousirtg Har,•+ai a.~ Se-,~ing Ir titu:icns <br /> Au:hvri:y ... N+:.n-dan•es:iv (ncn-°JSi <br /> Entitt <br /> <br />19E-22 <br />