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MINNESOTA <br /> BOARD OF GOVERNMENT <br /> INNOVATION AND COOPERATION —sem Use Only— <br /> Date Received: <br /> 1995 PRE-APPLICATION <br /> COVER PAGE Grant Number: <br /> 1. Applicant Name(s) List all proposed applicants. <br /> 2. Contact Person This person should be able to respond to questions regarding the pre-application. <br /> Name: Address: <br /> Title: <br /> Agency: <br /> Telephone Number: Fax Number: <br /> 3. Grant Program Identify the grant category for which you are submitting this proposal. <br /> ❑ Service Budget Management Model grant ($50,000 maximum) <br /> ❑ Cooperation Planning grant ($50,000 maximum) <br /> ❑ Service Sharing grant ($100,000 maximum) <br /> 4. Estimated Costs <br /> Total estimated cost of the proposal $ <br /> Estimated grant request $ <br /> This pre-application is submitted to the Board of Government Innovation and Cooperation pursuant to <br /> M.S. 465.798, 465.799, or 465.801. To the best of my knowledge, the information contained in this <br /> proposal is accurate and complete. <br /> (Signature) (Title&Local Government Unit or Organization) (Date) <br /> (The cover page must be signed by the senior elected or administrative official of one applicant agency.) <br /> The Pre-application must be returned to the Board Office no later than <br /> 5:00 p.m., November 22, 1995. <br /> (SEE OTHER SIDE) <br />