PART I - FACE SHEET

APPLICATION FOR FEDERAL ASSISTANCE
Modified Standard Form424 (Rev.02/07 to confirm to the Corporation's eGrants System)
1. TYPE OF SUBMISSION:
Application X Non-construction
2a. DATE SUBMITTED TO CORPORATION FOR NATIONAL AND COMMUNITY SERVICE (CNCS):
2b. APPLICATION ID:
17AC190587
3. DATE RECEIVED BY STATE:
01/13/17
STATE APPLICATION IDENTIFIER:
4. DATE RECEIVED BY FEDERAL AGENCY:
FEDERAL IDENTIFIER:
15ACHFL0020008
5. APPLICATION INFORMATION
LEGAL NAME: After-School All-Stars
DUNS NUMBER: 837280692
ADDRESS (give street address, city, state, zip code and county):
5670 Wilshire Blvd
Ste 620
Los Angeles CA 90036 - 5683
County: Los Angeles
NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS APPLICATION (give area codes):
NAME: Michael Brown
TELEPHONE NUMBER: (813) 787-9407
FAX NUMBER:
INTERNET E-MAIL ADDRESS: michael.brown@as-as.org
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
954441208
7. TYPE OF APPLICANT:
7a. National Non Profit
7b. National Non-Profit (Multi-State)
8. TYPE OF APPLICATION (Check appropriate box).
XNEW NEW/PREVIOUS GRANTEE
CONTINUATION AMENDMENT
If Amendment, enter appropriate letter(s) in box(es):
A. AUGMENTATION B. BUDGET REVISION
C. NOCOST EXTENSION D. OTHER (specify below):
9. NAME OF FEDERAL AGENCY:
Corporation for National and Community Service
10a. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 94.006
10b. TITLE: AmeriCorps State
11.a. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
ASAS Tampa
11.b. CNCS PROGRAM INITIATIVE (IF ANY):
12. AREAS AFFECTED BY PROJECT (List Cities, Counties, States, etc):
Pinellas County, Florida
13. PROPOSED PROJECT: START DATE: 08/01/17 END DATE: 07/31/18
14. CONGRESSIONAL DISTRICT OF:   a.Applicant CA 33   b.Program FL 14
15. ESTIMATED FUNDING: Year #: 1
a. FEDERAL
$ 207,371.00
b. APPLICANT
$ 86,693.00
c. STATE
$ 0.00
d. LOCAL
$ 0.00
e. OTHER
$ 0.00
f. PROGRAM INCOME
$ 0.00
g. TOTAL
$ 294,064.00
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS?
YES. THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON:
DATE:
XNO. PROGRAM IS NOT COVERED BY E.O. 12372
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
YES if "Yes," attach an explanation. XNO
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a. TYPED NAME OF AUTHORIZED REPRESENTATIVE:
Emely Martinez
b. TITLE:
c. TELEPHONE NUMBER:
d. SIGNATURE OF AUTHORIZED REPRESENTATIVE:
e. DATE SIGNED:
05/16/17