Attachment A:REQUEST FOR STATEWIDE RAPID RESPONSE FUNDS COVER PAGE

Cover Page

LWDB Applying for Funding: ____________________________________________Date Submitted: __________________

The Request for Statewide Rapid Response Funds Application has been reviewed for completeness. The submission includes the required elements:

o Cover Pageo Executive Summary/Signature Pageo Attachment B – Scope of Worko Attachment C – Partner Roles, Responsibilities, and Resourceso Attachment D – Budget Summary/Expenditure Plano Project dependent documents:

o Attachment E-Statewide Rapid Response Employer Layoff Data Formo Attachment F-Statewide Rapid Response Layoff Aversion Data Formo Attachment G-Additional Funds Workbooko Rapid Response Employee Survey Resultso Partner Support Letterso Employer Support Letters

____________________________________ _______________________________ Applicant Designee Signature Rapid Response Coordinator Signature

____________________________________ _______________________________Applicant Designee Name/Title Rapid Response Coordinator Name

This Request for Statewide Rapid Response Funds Application has been reviewed and supported by the Grant Recipient Locality.

____________________________________Grant Recipient Signature

____________________________________Grant Recipient Name/Title

REQUEST FOR STATEWIDE RAPID RESPONSE FUNDS

Executive Summary / Signature Page

LWDB Applying for Funding: ____________________________________________Requested Funding Supports: [ ] Single LWDB [ ] Multi-LWDB

Amount of Funding Requested (From Attachment D) $Amount of Other Leveraged Resources (From Attachment C) $

Designated Contact Person/Title: _____________________________________________

Contact Information: ___________________ _____________________Email Telephone

PROJECT TITLE: ____________________________________________________

Executive Summary:

Approval of Applicant:Name/Title: __________________________________________Signature/Date: __________________________________________

If Multi LWDB:____________________________ ___________________________Name/Title Signature

____________________________ ___________________________Name/Title Signature