Form 1 GADS

OMB Control Number: 0970-0328

Expiration Date:

Grant Application Data Summary (GADS) Form

The Paperwork Reduction Act of 1995: Public reporting burden for this collection of information is estimated to average 1/2 hour per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number.

1. Applicant Name:      		2. State:      
3. EIN (Employer Identification Number as assigned by the Internal Revenue Service:      		4. DUNS Number (Provide Data Universal Numbering System number received from Dun and Bradstreet):      
5. Federal Amount Requested (Provide dollar amount requested for each one year budget period):
Year 1:      	Year 2:      		Year 3:      
6. Proposed project time frame:
12 Months	24 Months		36 Months
7. Applicant Type (Choose ONE that best applies) Federally Recognized Indian Tribe Consortia of Indian Tribes Incorporated Non-Federally Recognized Tribe Incorporated Non-Profit Multi-Purpose Community-Based Native American Organization Urban Indian Center National or Regional Incorporated Non-Profit Native American Organization Alaska Native Village (Federally Recognized) Alaska Non-Profit Village Consortia Incorporated Non-Profit Alaska Native Multi-purpose Community Based Organization Non-Profit Alaska Native Regional Corporation/Association in Alaska Non-Profit Native Organization in Alaska Public or Non-Profit Private Agency Serving Native Hawaiians Agency Serving Native Peoples from Guam, American Samoa, or Northern Mariana Islands Tribally Controlled College or University, or Post-Secondary Vocational Institution College or University Located in HI, GU, AS or MP Serving Native Pacific Islanders Non-Profit Alaska Native Community Entity or Tribal Governing Body Other Tribal or Village Organization Tribal Governing Body
8. Partnerships (Collaborations) - Choose all that apply: Other Federal Agencies Community Organizations National/Local Non-Profit Organizations Tribes State or Local Government Private Business Philanthropic Organizations Faith-Based Organizations
9. Projected number of jobs created (Please provide ANA the number of jobs you anticipate creating if you are awarded an ANA grant):      
10. Will Youth be participating in this project? Yes No If Yes, how many are projected to participate:      
11. Will Elders be participating in this project? Yes No If Yes, how many are projected to participate:      
12. Please choose the competitive area, for which you are applying for funding (SEDS, SEDS Alaska, Family Preservation, Environmental, and Native Language).
Social and Economic Development Strategies (SEDS) Under this competitive area, please check only ONE ANA program area of interest that best describes the focus of your project i.e., only ONE check mark per applicant:
Economic Development Business Development Community Strategic Planning Organizational Capacity Building Subsistence Project Emergency Response Activities Transportation for Elders and Disabled Transportation for Workforce Development International Tourism and Trade Job Training
Social Development Youth Development Cultural Preservation Activities Education Development Foster Parent Training Supporting Elders Supporting People with Disabilities
Governance Tribal Government Program Enhancement Management and Leadership Development Information Management Systems Codes and Ordinances Constitutional Reform Operational Planning Tribal Court Systems
Social and Economic Development Strategies - Alaska (SEDS-AK) Under this competitive area, please check only ONE ANA program area of interest that best describes the focus of your project i.e., only ONE check mark per applicant:
Economic Development Business Development Community Strategic Planning Organizational Capacity Building Subsistence Project Emergency Response Activities Transportation for Elders and Disabled Transportation for Workforce Development International Tourism and Trade Job Training Traditional Energy Activities
Social Development Youth Development Cultural Preservation Activities Education Development Supporting Elders Supporting People with Disabilities
Governance Tribal Government Program Enhancement Management and Leadership Development Information Management Systems Codes and Ordinances Constitutional Reform Operational Planning Tribal Court Systems
Special Initiative: Family Preservation: Improving the Well-Being of Children Planning
Please choose one or more relevant options from the selection below: Curriculum Development Community Assessment Develop a Family Preservation Strategic Plan Please choose all relevant topics from the selection below: Relationship and Marriage Education for Adults Relationship and Marriage Education for Youth Marriage Enrichment activities and services Pre-marital education and marriage skills Relationships Skills Responsible Fatherhood or Parenting Family preservation activities offered in a culturally appropriate and traditional manner   Absentee parent services, education and activities Reduce child/infant abuse and neglect and family domestic violence Needs of grandparents raising grandchildren Foster Parent Training Family strengthening services to individuals with substance abuse issues Public Advertising Campaigns (not applicable for curriculum development) Research (not applicable for curriculum development)
Special Initiative: Family Preservation: Improving the Well-Being of Children Implementation
Please choose all relevant topics from the selection below: Relationship and Marriage Education for Adults Relationship and Marriage Education for Youth Marriage Enrichment activities and services Pre-marital education and marriage skills Relationships Skills Responsible Fatherhood Parenting Family preservation activities in a culturally appropriate and traditional manner   Absentee parent services, education and activities Family Domestic Violence Grandparents raising grandchildren Foster Parent Training Family strengthening services to individuals with substance abuse issues Public Advertising Campaigns Research
Environmental Regulatory Enhancement Under this competitive area, please check only ONE ANA program area of interest that best describes the focus of your project i.e., only ONE check mark per applicant:
Environmental Assessment Infrastructure Improvement Develop Regulations, Ordinances, or Laws Develop a Technical Program Training Enforcement Energy Assessment Energy Projects for Export Renewable Energy Resources
Native Language Preservation and Maintenance Assessment
Please choose one or more relevant options from the selection below: Data Collection Formal Language Assessment Informal Language Assessment
Native Language Preservation and Maintenance Planning
Please choose one or more relevant options from the selection below: Plan and design Master/Apprentice programs Plan and design comprehensive Native language immersion programs for a language nest or survival school Plan, design and test curriculum for students, parents and language instructors Plan and design teaching materials Record, transcribe and archive oral testimony Plan and design language resource materials using recorded oral testimony Plan and design multi-media language learning tools Plan and design teacher certification programs Train teachers, interpreters or translators of Native languages
Native Language Preservation and Maintenance Implementation
Please choose one or more relevant options from the selection below: Produce/disseminate culturally relevant printed stories for children using the Native language of the community Facilitate/encourage intergenerational teaching of Native American language skills Disseminate culturally relevant materials to teach and enhance the use of Native American languages Implement an immersion, mentor or distance learning model Produce, distribute or participate in various media forms to broadcast Native languages Implement an educational site-based immersion project
Native Language Preservation and Maintenance Immersion
Please choose only one option from the selection below: Language Nest Language Survival School