Please use the following format to submit your letter of intent to participate in
the FEMA 2012 Nationally Competitive Pre-Disaster Mitigation Grant Program.
Project Intent to Apply
Submit as an email attachment to:
State Hazard Mitigation Officer
Division of Homeland Security and Emergency Management
P. O. Box 5750
Fort Richardson, AK 99505-5750
Applicant / Agency:
Signature of person applying:
Typed / Printed Name
Primary Name:
Title:
Address:
Phone:
Fax:
Email:
Alternate Name:
Title:
Address:
Phone:
Fax:
Email:
Name of Community/State Agency
Eligibility:
Tribe,
Community,
State Agency,
Private Non-Profit (PNP)
If Private Non- Profit
Attach copy of documentation (By-Laws, Charter, IRS)
Federal Employer Identification
Number (EIN)
If Indian Tribe, use Tribal
Identification Number (TIN)
Is the applicant delinquent on
any Federal debt?
Is the community a small and
impoverished community as
defined by the State Hazard
Mitigation Plan (Appendix 12)
Yes
No
Yes
No
Explain:
Activity Cost Estimate:
$
Describe below how the proposed activity relates to or is consistent with Alaska’s State Hazard Mitigation
Plan. Alaska’s State Hazard Plan is available at:
http://ready.alaska.gov/plans/documents/SHMP_2010_UPDATE_ENTIRE_FINAL_COMPLETE.pdf)
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Project Grant Summary:
Project Name:
Project Location:
Project Description (attach additional pages as needed):
Does your community participate in
Yes
No
NFIP?
Is your community eligible to join
Yes
No
NFIP?
Does your community have a Local Hazard Mitigation Plan?
Is the recipient participating in the Community Rating System (CRS)?
Is the recipient a Firewise Community?
* Has the recipient adopted building codes consistent with the International
Codes?
* Has the recipient adopted the National Fire Protection Association (NFPA) 5000
Code?
* Have the recipient's building codes been assessed on the Building Code
Effectiveness Grading Schedule (BCEGS)?
No
No
No
No
Yes
No
Yes
No
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5
9
If yes, what is their BCEGS rating?
Environmental/Historic Preservation
Information
Is CATEX review applicable?
Is CATEX review completed?
Does this project involve a historical
structure or edifice?
Yes
Yes
Yes
Yes
Yes
Yes
Yes
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No
No
No Explain:
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6
10
3
7
4
8