Funds Awarded Form Please complete and submit the form below. All fields are required. "*" indicates required fields Local Government Name* Entity’s Taxpayer Identification Number* DUNS number* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Authorized Representative's InformationName* First Last Representative's Title* Email* Enter Email Confirm Email Contact Person's InformationName* First Last Representative's Title* Phone*Email* Email Confirm Email Allocation of FundingThe NEU has the option to transfer funds to the State under Section 603(c)(4) of the Act. As part of this process, the NEU must provide a signed notice to the State, which the State must transmit to Treasury. If the NEU does not provide such notice, it will remain legally obligated under the award with respect to accounting for the uses of the funds and the reporting on such uses.Does the organization choose to accept or decline the funding allocation?*If the NEU selects to decline the allocation of funds, the Treasury will consider this action as a cancellation of the award on the part of the eligible NEU. My organization chooses to accept the funds My organization chooses to DECLINE the funds Financial Institution InformationNumber*Number*Institution Name* Phone*Email* Total NEU Budget*This is defined as the annual total operating budget, including general fund and other funds, in effect as of January 27, 2020 or top-line expenditure total (in exceptional cases in which the NEU does not adopt a formal budget). Documentation in support of the reported budget will have to be provided to Treasury along with the NEU's first report due by October 31, 2021. Is the amount of money the organization is receiving more than 75% of the organization's annual budget?* No, the amount we are receiving is less than 75% Yes, the amount we are receiving is more than 75% Award Terms and Conditions Agreement*As provided by the Treasury, please download to sign the form here. [PDF]Accepted file types: pdf, Max. file size: 50 MB.Assurances of Compliance with Title VI of the Civil Rights Act of 1964*Please download to sign the form here. [PDF]Accepted file types: pdf, Max. file size: 50 MB.SignatureDate MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.