State of Tennessee

CDBG-CV Addressing Food Insecurity Application

General Information

Applicant (County):*

Applicant Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Amount of Grant Request:* $

Amount of Leveraged Funds:* $

Total Project Cost: $

Applicant FEIN:*

Applicant DUNS:*

Applicant SAM Unique ID:*

County Mayor/Executive*

First Name

Last Name

Application Preparer (Administrator)*

First Name

Last Name

Short Answer

Preparer Organization/Firm*

Application Preparer Email*

Confirm Application Preparer Email *

Project Information

Brief project description (a couple of sentences):*

Describe the proposed project in detail. Describe the current state of service and coverage of partner agencies to address the food insecurity needs in your county. Include data where available to support the need for the proposed project.*

Pandemic Tieback

Explain how COVID-19 has impacted the need for access to food resources. Explain the need pre-pandemic to now:*

Describe in detail how the proposed project will address the impacts of COVID-19 or a future pandemic:*

CDBG-CV Compliance

Clearly detail how an eligible National Objective is being met by the proposed project. (Typically this will be benefitting low and moderate income (LMI) populations.)*

Download: TN LMI Communities

Have the applicant or any of the of benefitting partner agencies received state or federal pandemic-related stimulus funds to assist with operations or physical improvements for food access or distribution? *

No Yes

Community Benefit

Describe the community or areas served by each of the partner agencies included in the application.*

Total number of people currently served by all partner agencies collectively. (Weekly)*

Total number of people projected to served by all partner agencies collectively after completion of the project. (Weekly)*

Attachments and Application Submission

Application Attachment Templates

Addressing Food Insecurity Partner Agency Summary

Addressing Food Insecurity Project Budget

Addressing Food Insecurity Grant Assistance Agreement

Addressing Food Insecurity Stimulus Funds Disclosure

ERR Exempt Form

Partner Agency Summary*

No File Chosen