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Project Change Request Form

This form must be completed and submitted to NCTCOG staff on behalf of REPAC Chairs and Urban Area Executive Committee in order to request any project changes for any Homeland Security Grant Programs (HSGP).

1. Primary Grant Point of Contact:
Jurisdiction
Name
Title
E-Mail
Phone
 
2. Enter the amount of funding received from each grant program for this project.
(Do not use dollar signs or commas when entering amounts)
2013 UASI 2014 UASI
 
 

3. Select the regional priorities that your newly proposed project applies to: (check all that apply)

Interoperable Communications 
Emergency Response limited to special response teams
Enhance Citizen/Community Preparedness
 
4. Explain in detail the original project that was awarded to your jurisdiction:
5. Explain in detail what your project change proposal is, please include budget detail and any recurring costs associated:
 
6. Provide justification/rationale for this project change request:
 
7. Explain the regional impact of this proposed project change.
 
8. Has this project received funding from any other sources both local and/or other grant programs? If so, please explain.
 

SHSP/LETPP: This project change proposal will be presented to the REPAC chairs for review/approval.
UASI:
This project change proposal will be emailed to the UASI Executive Committee.

The primary contact listed above will be notified of approval or issues concerning the change.

   

 

 
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