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I <br />I <br />I <br />I <br />I <br />I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> <br /> I <br /> <br /> I <br /> I <br /> I <br /> I <br /> I <br /> <br />Department of Children, Families & Learning <br />Division of Management assistance <br />1500 Highway 36 West <br />Roseville, MN 55113 <br />651/582-8864 <br /> <br />Application Form <br /> <br />Project Name: <br /> <br />Name of Application Organization: (Must be a Public Entity), <br /> <br />Add ress: <br /> <br />Chief Executive: <br /> <br />Contact Person: <br /> <br />Telephone: <br /> <br />Project Description: <br /> <br />Grant Amount Requested: <br /> <br />Cost of Total Project: <br /> <br />Proposed Length of Project: Start Date <br /> <br />Completion Date: <br /> <br />Sources and Amount of Matching Funds (If Any) <br /> <br />Year Round Program Yes <br />New Program Yes <br />Expansion of Existing Program <br /> <br />No <br /> <br />Yes No <br /> <br />Authorized Signature <br /> <br />10 <br /> <br /> <br />