Congressman Earl Blumenauer - Appropriations Request Form

PORTLAND:
729 N.E. Oregon Street
Suite 115
Portland, OR 97232
t: (503) 231-2300
f: (503) 230-5413

WASHINGTON D.C.:
2267 Rayburn House Office Building
Washington, DC 20515
t: (202) 225-4811
f: (202) 225-8941

Appropriations Request Form

Wednesday, 21 January 2009

APPROPRIATIONS REQUEST FORM

OREGON HOUSE DELEGATION

FISCAL YEAR 2010

DEADLINE FOR SUBMISSION: FEBRUARY 13, 2009

PLEASE NOTE: As required by the House Appropriations Committee, all requests will be made public on the requesting Member's website.

1. Project Title:

2. Organization Name and address:

3. Primary Contact name, phone number, mobile phone number, fax number and email:

4. Project Location Address (if different from Organization):

5. Please describe the requesting organization’s main activities, and whether it is a public, private non-profit, or private for-profit entity:6. Briefly describe the activity or project for which funding is requested (please keep to 500 words or less.)7. Has this project received federal appropriations funding in past fiscal years?

6. Briefly describe the activity or project for which funding is requested (please keep to 500 words or less.)

7. Has this project received federal appropriations funding in past fiscal years?

7a. If yes, please provide fiscal year, Department, Account, and funding amount of any previous funding.

8. Federal agency and account from which funds are requested (Please be specific –e.g. Department of Housing and Urban Development, Economic Development Initiatives account):

9. What is the purpose of the project? Why is it a valuable use of taxpayer funds? How will the project support efforts to improve the economy and create jobs in Oregon?

10. Have you requested funding for this project from other Members of Congress?
If so, who?

11. Funding Details:

a. Total project cost (all funding sources and all years):

b. Amount being requested for this project in Fiscal Year 2010:

c. What other funding sources (local, regional, state) are contributing to this project or activity? (Please provide specific dollar amount or percentage.)

d. Do you expect to request federal funding in future years for this project?

e. Breakdown/budget of the amount you are requesting for this project in FY 2010.
(e.g. salary $40,000; computer $3,000):

f. Please list public or private organizations that have supported/endorsed this project:

g. Is this project scalable? (i.e. if partial funding is awarded, will the
organization be able to use the funds in FY 2010?):

Please return this form no later than February 13, 2009 (via email) to: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it