HSGP Grant Application

MISSISSIPPI OFFICE OF HOMELAND SECURITY
HOMELAND SECURITY GRANT PROGRAM

GRANT APPLICATION
AGENCY INFORMATION
NAME OF AGENCY*
MAILING ADDRESS*

Street Address

Street Address Line 2

City

Postal / Zip Code
AGENCY CONTACT NAME*

First NameLast Name
AGENCY CONTACT TITLE
AGENCY CONTACT EMAIL ADDRESS*
example@example.com
AGENCY CONTACT PHONE NUMBER
Please enter a valid phone number.Format: (000) 000-0000.
SIGNATORY AUTHORIZED OFFICIAL *
(Name of Mayor, Board President, Commissioner, Head of Agency, etc.)
AUTHORIZED OFFICIAL EMAIL*
example@example.com
UEI/SAMs NUMBER*
UEI/SAMs Expiration Date*

MonthDayYear
Date
Select your CONGRESSIONAL DISTRICT
FUNDING REQUEST BY COST CATEGORY

COST CATEGORY*

AGENCY DEMOGRAHIC INFORMATION*

AGENCY TYPE *
IF "OTHER" IS SELECTED PLEASE DESCRIBE IT HERE.
II. AGENCY'S TOP TERRORISM THREAT & TERRORISM HAZARD
TERRORISM THREAT is a technological or human-caused occurrence by an individual, entity, or action that has or will cause the potential to harm life, information, operations, the environment, and/or/ property.
BRIEFLY DESCRIBE THE AGENCY'S TOP TERRORISM THREAT*
TERRORISM HAZARD is a potentially dangerous or harmful threat that can have unwanted outcomes. Hazards can include threats of terrorism, bomb scares, bombings, the use of chemical, nuclear, and radiological weapons. A hazard is an intent to cause mental or physical injury or death for the purpose of advancing a person, organization, or agenda of extreme fear and intimidation.
BRIEFLY DESCRIBE THE AGENCY'S TOP TERRORISM HAZARD*

GRANT BUDGET REQUEST
All information provided in the Grant Budget section is a request. There are no guarantees for funding. Funding may be partial. Please provide items in order of priority and NEED. Items MUST be justifiable for the needs listed above for threats and hazards.
CONTRACTUAL SERVICES

Contractual Services should be requested for one (1) year of service only. All expenses must be in accordance to current state and federal guidelines. The Agency should be prepared to be able continue contractual services , if future awards or services are not approved.

Contractual Services Budget

TOTAL COST OF CONTRACTUAL SERVICES
EQUIPMENT

All equipment must be on the FEMA Authorized Equipment List (AEL). You can find the AEL at https://www.fema.gov/grants/tools/authorized-equipment-list. Equipment MUST be for terrorism based programs and activities. (See Funding Guidance for more information).

Equipment Budget

TOTAL COST OF EQUIPMENT
COMMODITIES/SUPPLIES

Include a detailed assessment of other grant expenses within the program area in which you are applying. Also, include a cost estimate for all additional grant expenses (e.g. gloves, traffic safety cones, flashlights, reflective safety vest, triage kits, etc.) All expense must be in accordance to current state and federal guidelines. These items are disposable and not equipment.

Commodities/Supplies Budget

TOTAL COST OF COMMODITIES/SUPPLIES
OTHER EXPENSES

Additional items listed in this category must have detailed justification for requests. These items do not fall within any of the above listed categories.

Other Expenses Budget

Rows	Type of Expense	Description of Other Expense	QTY of Other Expense	Cost of Other Expense	Total of Other Expense
Other Expense 1
Other Expense 2
Other Expense 3
Other Expense 4
Other Expense 5

APPLICATION SUBMISSION COMPLIANCE/APPLICATION CONTACT

I certify that I am an employee of the aforementioned agency or have been hired by the agency to apply on their behalf for the Grant. All parties have knowledge and approved of the contents of this Application, Budget Request, and all information provided within.
Applicant Name*

First NameLast Name
Applicant Title
Applicant Signature*

Clear
Please print a copy of your application for your records before you click the submit button.
Should be Empty:

MISSISSIPPI OFFICE OF HOMELAND SECURITY