Please use the following format to submit your letter of intent to

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Please use the following format to submit your letter of intent to Powered By Docstoc
					                   Please use the following form to submit your letter of intent to participate in
                                      the Hazard Mitigation Grant Program.
                                                  Project Intent to Apply
                                            Submit as an email attachment to:
                                        State Hazard Mitigation Officer
                         Division of Homeland Security and Emergency Management
                                                P. O. Box 5750
                                       Fort Richardson, AK 99505-5750
Applicant / Agency:
Signature of person applying:
Typed / Printed Name
Primary Name:
Title:
Address:
Phone:
Fax:
Email:
Alternate Name:
Title:
Address:
Phone:
Fax:
Email:
Name of Community/State Agency
Eligibility:                                    Tribe,    Community,     State Agency,
                                                Private Non-Profit (PNP)
If PNP                                          Attach copy of documentation (By-Laws, Charter, IRS)
Federal Employer Identification
Number (EIN)
         If Indian Tribe, use Tribal
Identification Number (TIN)
Is the applicant delinquent on                  Yes            No   Explain:
any Federal debt?
Is the community a small and                    Yes            No
impoverished community as
defined by the State Hazard
Mitigation Plan (Appendix 9)
Activity Cost Estimate:          $
Describe below how the proposed activity relates to or is consistent with Alaska’s FEMA-approved State
Hazard Mitigation Plan.




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Project Grant Summary:
Project Name:
Project Location:

Project Description (attach additional pages as needed):




Does your community participate in             Yes         No
NFIP?
Is your community eligible to join             Yes         No
NFIP?
Does your community have a Local Hazard Mitigation Plan?                           Yes        No
Is the recipient participating in the Community Rating System (CRS)?               Yes        No
Is the recipient a Firewise Community?                                             Yes        No
* Has the recipient adopted building codes consistent with the International       Yes        No
Codes?
* Has the recipient adopted the National Fire Protection Association (NEFA) 5000   Yes        No
Code?
* Have the recipient's building codes been assessed on the Building Code           Yes        No
Effectiveness Grading Schedule (BCEGS)?
                                                                                   1     2    3    4
If yes, what is their BCEGS rating?                                                5     6    7    8
                                                                                   9     10

Environmental/Historic Preservation
Information
Is CATEX review applicable?                             Yes        No
Is CATEX review completed?                              Yes        No
Does this project involve a historical                  Yes        No Explain:
structure or edifice?




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posted:10/5/2012
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