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Cabarrus County Active Living & Parks Department Attachment A <br />P.O. Box 707, Concord, NC 28026 -0707 <br />MATCHING INCENT/ VE GRANT APPLICANT INFORMATION FORM <br />1. APPLICANT INFORMATION <br />ORGANIZATION NAME <br />NON- PROFIT <br />YES NO <br />ADDRESS <br />PHONE NUMBER <br />FAX NUMBER <br />OTHER NUMBER <br />PROJECT COORDINATOR'S NAME <br />EMAIL ADDRESS <br />ADDRESS <br />PHONE NUMBER <br />FAX NUMBER <br />OTHER NUMBER <br />SCHOOL PRINCIPAL'S NAME (IF PROJECT LOCATED ON SCHOOL PROPERTY) <br />EMAIL ADDRESS <br />ADDRESS <br />PHONE NUMBER <br />FAX NUMBER <br />OTHER NUMBER <br />2. PROJECT INFORMATION <br />DESCRIPTIVE TITLE OF PROJECT <br />PROJECT SITE <br />STREET ADDRESS <br />CITY <br />STATE <br />ZIPCODE <br />AREAS AFFECTED BY PROJECT: <br />(SCHOOLS, MUNICIPALITIES, ETC.) <br />NEW PROJECT <br />ON -GOING PROJECT <br />START DATE <br />COMPLETION DATE <br />WILL A FEE BE CHARGED FOR USE <br />OF FACILITY /PROJECT? <br />YES NO <br />ON -GOING MAINTENANCE FOR PROJECT WILL BE PROVIDED BY <br />ESTIMATED FUNDING: <br />APPLICANT $ <br />COUNTY $ <br />IN -KIND $ <br />TOTAL $ <br />TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION IS TRUE AND CORRECT. THE <br />DOCUMENT HAS BEEN AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL <br />COMPLY WITH THE ATTACHED ASSURANCES IF THE GRANT IS AWARDED. <br />TYPED NAME OF PROJECT COORDINATOR <br />SIGNATURE OF PROJECT COORDINATOR <br />Attachment number 1 \n <br />F -2 Page 115 <br />