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MINNESOTA <br /> BOARD OF GOVERNMENT —State Use Only— <br /> INNOVATION AND COOPERATION <br /> Date Received: <br /> 1995 SERVICE SHARING <br /> GRANT APPLICATION <br /> COVER PAGE <br /> 1. Grant Number Indicate the grant number assigned by the Board to your pre-application. <br /> -95- <br /> 2. Abstract Describe your proposed project by completing the following sentence. Indicate the <br /> service or progra-rn-you-plan-to-deliver-jointly -This application requests funding for the start-up costs of providing fully integrated ... <br /> 3. Grant Request Indicate the amount offunding you are requesting from the Board. <br /> $ ($100,000 maximum) <br /> 4. Applicant Names List all applicants; they may differ from the applicants listed on your pre-application. <br /> Indicate which applicant will act as the project's fiscal host if you are awarded a grant: <br /> 5. Contact Person The contact person should be able to respond to questions regarding this application. <br /> Name: Address: <br /> Title: <br /> Agency: <br /> Telephone Number: Fax Number: <br />