Fire Service Advisory Committee Funding Proposal Application

Name of organization*

Address of organization*

Street Address

Street Address Line 2

CityState

Zip Code

Business type*

Secretary of State filing number*

Enter N/A if government entity

Primary contact person*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

In accordance with 299F.012, eligible recipients must meet one of three purposes

Please select the purpose that your proposal meets*

Minnesota Board of Firefighter Training and EducationPrograms and staff for the State Fire Marshal divisionFire-related regional response team programs and any other fire service programs that have the potential for statewide impact

Summary background of organization*

In 500 words or less provide a summary background on your organization so we can learn more about your mission and scope of work.

Project proposal*

In 500 words or less provide details on what the funding will go towards (i.e., equipment, contracts, staff time, etc.)

Project need*

In 500 words or less provide reasoning on the need for funding. When applicable, provide links to specific standards, statutes, or industry best practices.

Project outcomes*

In 500 words or less provide details on the desired outcomes of the project and how they link to the purpose of these funds in 299F.012. Funding request

Amount requested for proposal*

If awarded funding, will there be ongoing costs after completion of the proposal?*

YesNo

Provide an explanation on how you intend to fund the project past this allocation outside of FSAC.*

Acknowledgements*

I acknowledge that this application is for a one-time funding request and that ongoing approval or funding for this project is not guaranteed.I acknowledge that funding recommended by the FSAC and allocated by the Commissioner of Public Safety is available for the time specified in the allocation letter.I acknowledge and understand that DPS and the FSAC require a written, post project report upon completion of my project.I understand that I must give a presentation on the proposal to the FSAC if my application is approved as eligible for funding consideration.I understand that I must meet and maintain compliance with all applicable federal, state, and local laws, ordinances, rules, and regulations including any applicable business registration requirements of the Office of the Secretary of State before through the duration of my project.

Name*

First NameLast Name

Title*

Date*

Date

Signature*

Please verify that you are human*