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Personal Information
Name:*
               
Salutation First Name Middle Name Last Name
Title:
Address:*


*
           
City State/Province Postal Code/Zip
County
City Outside NH:
Enter City name if 'Other-not in NH' is selected above
Phone:*
       
Phone (999-999-9999) Ext.
alternate phone number
alternate phone type
Fax:
(999-999-9999)
Email:*
Confirm Email*
Second Address
An Authorized Official (AO) is the highest level user within the municipality or organization. The AO is responsible for certifying that the application submissions by the organization are as accurate as they can be and have been approved by him/her prior to being submitted to CDFA. The AO can perform all applicant organization related functions.

The AO may not necessarily be the person that performs the most work on the grant-related items in the system. The AO can assign an employee of their organization or an independent grant writer to complete the application, however, only the AO has the ability to authorize the submission of grant applications.
Authorized Official * Yes No
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Organization Information
Name:*
Type:*
Tax ID:
Website:
Year Founded:
Fiscal Year End: Date Picker 
Address:*
City/State/Zip*
           
City State/Province Postal Code/Zip
City Outside NH:
Enter City name if 'Other-not in NH' is selected above
County
Phone:*
       
(999-999-9999) Ext.
Fax:
(999-999-9999)
This information will be used to notify the A.O on issues relating to the application and/or grant.
Authorized Official*
Authorized Official Email Address*
Don't have a DUNS #? Click here to apply.
DUNS Number (Required):*
(99-999-9999)
Executive Council District*
Don't have a CCR #? Click here to apply.
CCR CAGE Number (Central Contractor Registry)
NAICS Code
Number of Paid Staff:
Number of Board of Directors:
Geographic Area Served:
Community Activities:
(Mission Statement)
What program(s) are you interested in?*

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