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Fiscal Year 2021 (July 1, 2020 - June 30, 2021) Funding Request

  1. Fiscal Year 2021 Funding Request

    If Organization is awarded Fiscal Year 2021 funding, information provided in this form will be used to develop a contractual Agreement between the Recipient and the City of Dubuque. The Agreement will contain outcomes and indicators necessary to evaluate and monitor progress towards meeting identified City Council Goals. Agreement. "Agreement" means the Agreement and all of the leases, assignments, and similar documents identified in the Agreement and all other instruments or documents executed by the Recipient or otherwise required in connection with the Agreement, including the information from the Application together with any related submittal documents. Completion of this form does not constitute an Agreement with the City of Dubuque.

  2. Recipient Information

    Recipient. "Recipient" means any public or private agency, institution, organization, or other entity or any person receiving directly, or through any successor, assignee, or transferee of a receipt, but excluding the ultimate beneficiary, of financial assistance from the City of Dubuque.

  3. Full legal name of Recipient, as it should appear in the Agreement.

  4. Person authorized to legally enter Agreement or contract with the City of Dubuque on behalf of the recipient.

  5. Ex: Executive Director, Board Chair

  6. Primary Contact for Project

    Project. "Project" means a discrete item of work as determined to be eligible for funding through Agreement with the City of Dubuque.

  7. Should the Agreement be mailed to the Recipient mailing address listed above?

  8. Project Funding Request and Timeline

  9. Include information on concept development, planning, production/operation, completion, and evaluation.

  10. Enter the desired time of performance for the Project. The services of the Recipient are to commence as of the Agreement Start Date and shall be undertaken in such sequence as to assure their expeditious completion. All agreed upon services should be completed on or before the Agreement End Date.

  11. Performance Measures

  12. Check the location(s) where services will be provided:*

  13. The Project provides/creates:

  14. The long-term Project impact intends to provide/create:

  15. Sources & Uses

  16. Sources of Funding*

    In addition to funding from the City of Dubuque, please identify all sources of funding for the Project:

  17. At this time, is the cash match, scale, scope, or use of funding for the Project different than stated in the request for funding or the application?*

    Check all that apply.

  18. Thank you for partnership with the City of Dubuque. If your Organization is awarded funding through the Fiscal Year 2021 budget process, a representative will contact you in May 2020 to finalize a draft Agreement. Final agreements are subject to the City Council or designated authority.

  19. Leave This Blank:

  20. This field is not part of the form submission.