FY 2012 Homeland Security Grant Programs Application Deadline, uploaded by September 30, 2012

Application Checklist, completed: 1. This form. FY2012 Homeland Security Grant Programs (HSGP) Summary of Projects/Costs 2. EGMS User Information Form 3. Contact Information Sheet 4. Governance / Advisory Team membership 5. NIMS Compliance Information 6. EHP Review Form (as applicable) 8. Travel Pre-Approval Form (if applicable) 9. Training Pre-Approval Form (if applicable) 10. Exercise Pre-Approval Form (if applicable) Reminder: Eligible Projects must directly support specific State Investment Justification Milestones.

FY2012 HSGP Summary of Projects/Costs Jurisdiction: Award Amount: $

Project Title(s) (shown in order of priority, Admin does not require a priority #) Funding Budget 1. $ 2. $ 3. $ 4. $ 5. $ 6. $ 7. $ 8. $ 9. $ 10. $ --. Grant Administration (limited to5% of grant award if applicable) $ Total Funding (must equal Award Amount): $ With my signature below, I hereby certify that the Jurisdiction’s Governance/Advisory Team did on ______(insert date) review and concur on the projects, narrative, and budget costs contained within this grant application. Grant Signatory Official (signature) Date

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