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COVERPAGE <br />PROPOSER APPLICATION <br />Organization Legal Name <br />Organization DBA <br />$ <br />Program Name <br />Program Address <br />Corporate Office Address <br />Contact Person & Title <br />Email <br />Telephone # <br />Fax # <br />Federal ID Number <br />ORGANIZATION STATUS <br />Public Non - Profit <br />Corporation <br />$ <br />Private Non -Profit <br />Requested <br />Private for Profit <br />Government <br />Other <br />Years in Operation, <br />TARGET POPULATION <br />Older Youth Younger Youth Out -of- School In- School <br /># of Youth to be Served in 2015 -2016 <br />Total WIOA Funds <br />$ <br />Requested <br />In compliance with the RFP noted above, and subject to the conditions thereof, the undersigned offers to furnish <br />the services stipulated and certifies he has read, understands, and agrees to all terms, conditions, and <br />requirements of this RFP and is authorized to contract on behalf of the organization named above. <br />Signature <br />Title <br />Date <br />16 <br />19D -20 <br />