CASP IAFW APPLICATION FORM The commitment our agency must

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Date Received:
CASP IAFW APPLICATION FORM
Agency Name (in full):____________________________________________________________________________
Street Address:
P.O. Box:
City:
State/Province:
County:
ZIP/Postal Code:
Country:
Agency Telephone Number:
(If a P.O. Box is preferred, check here:
Agency Fax Number:
(Please also include street address for UPS deliveries)
Agency’s Chief Executive Officer:
Title:
Telephone:
Ext:
E-Mail:
Agency’s Accreditation Manager (if any):
Title:
Telephone:
Ext:
E-Mail:
The commitment our agency must make in working with the C ommission toward accreditation is
understood and accepted. Also, we are prepared to provide information promptly concerning
our agency that the Commission requires in making its determination for awarding a CASP
IAFW. It is also understood that our agency is entering into a non-adversarial working
relationship with the Commission and that our agency can terminate its applicant status at any
time prior to the awarding of the grant.
Date:
For the Agency:
NOTARY PUBLIC
by:
(Signature)
City/County of
State/Province of
The forgoing instrument was acknowledged
before me, this
day of
20
(Typed Name)
by:
(Title)
(Name of person seeking acknowledgement)
(Notary Public Signature)
My commission expires:
Date:
For the Governing Authority
NOTARY PUBLIC
by:
(Signature)
City/County of
State/Province of
The forgoing instrument was acknowledged
day of
before me, this
20
by:
(Typed Name)
___________________________________
(Title)
(Name of person seeking acknowledgement)
(Notary Public Signature)
My commission expires:
-2-
The following Application Narrative must be included in each application. Failure
to provide all information required will automatically disqualify an agency from
consideration.
The application narrative should consist of the following components:
Statem ent of Interest : Explain why the agency wants to become
accredited. Document both the agency’s and the governing body’s longterm commitment to the accreditation process. Indicate the current number
of sworn and civilian employees.
Budget Statem ent : Document the agency’s need for financial assistance.
The financial/budgetary authority should explain, in detail: (a) why
accreditation funds are not currently available, and, (b) what funds are
available to meet any costs that may be incurred in order for the agency to
comply with accreditation standards. The authority should also indicate the
existence of obligate funds for the estimated initial assessment fees, as well
as any other fiscal resources required to complete the initial accreditation.
In addition, the following information is also required:
• Total municipal/county budget (latest year available).
• Total agency budget (latest year available).
• Current number of full-time employees or FTE.
• Current number of part-time employees.
• Size of population area serviced, if applicable.
• Total value of any federal grants received and balances of these funds
as of last fiscal year.
• List of any Asset Forfeiture Funds (AFF) received in last 12 months and
current AFF balance.
Plan of Action : Describe the agency’s plan to complete the initial
accreditation process in the required time period. Identify internal and
external resources that will be utilized. Name the agency’s contact person in
this matter and/or Accreditation Manager.
Organizational
Capability :
Describe the agency’s experience in
conducting projects of a similar nature.
09/01/12
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