b) The Department will provide application instructions to potential applicants.

1. c) Completed applications shall be returned to the Department at the address indicated on the grant application form or submitted electronically as directed. All applications shall be submitted in the format prescribed by the Department and shall include, without being limited to, the following provisions:

   1. 1) The name, address, chief officers and general description of the applicant (Section 4(a)(1) of the Illinois Grant Funds Recovery Act);
   2. 2) A copy of the Applicant's W-9, Request for Taxpayer Identification Number and Certification;
   3. 3) The applicant's grant funding history, i.e., whether the applicant has received a grant from the federal government or the State of Illinois within the last three years; if yes, the agency providing the funding, the grant number, grant amount, grant term, and a brief description of the grant;
   4. 4) Information concerning the applicant's background and financial standing, including the applicant's overall annual budget;

2. 5) The following information concerning the applicant's organization:

   1. A) Legal status;

   2. B) Federal Employer Identification Number (FEIN);

      1. C) If applicable, all names and FEINs that are registered to the organization or have been registered during the last three years;
   3. D) Data Universal Numbering System (DUNS) Number;

   4. E) Illinois Department of Human Rights Number, if applicable;

      1. F) Legislative House District, Legislative Senate District, and Congressional District;
      2. 6) A general description of the program, project or use for which grant funding is requested (Section 4(a)(2) of the Illinois Grant Funds Recovery Act);
      3. 7) Plans, equipment lists and other documents necessary to show the type, structure and general character of the program, project or use for which grant funding is requested (Section 4(a)(3) of the Illinois Grant Funds Recovery Act);

3. 8) A scope of work for the funding period, including, but not limited to:

   1. A) A detailed description/information about the proposed project;

   2. B) Expected outcomes;

      1. C) A description of the evaluation methods to be used, a plan for monitoring the overall project, and how outcomes and objectives will be measured;
   3. D) A list of goals to be accomplished during the grant period;

   4. E) A proposed timeline;

      1. F) Objectives by quarter with a list of tasks that will be implemented to accomplish the objectives; and
      2. G) A personnel chart, only if an applicant has allocated grant funding toward salaries or wages. The chart shall provide the individual's name, position title and role, percentage of time dedicated to the grant project, and the amount budgeted to support the percentage of time invested in the project;
      3. 9) Cost estimates of developing, constructing, operating or completing the program, project or use for which grant funding is requested (Section 4(a)(4) of the Illinois Grant Funds Recovery Act);
      4. 10) A program of proposed expenditures for the grant funds (Section 4(a)(5) of the Illinois Grant Funds Recovery Act). The program shall be in the form of a detailed budget for the funding period, documenting sufficient resources to complete the objectives addressed in the work plan. The budget shall be by line item category and shall provide justification for the use of grant funds to support the project activities. The applicant shall indicate the total amount of funding requested from the Department and other sources of funding that are available to support the project, if applicable;
      5. 11) An approximate timetable for project completion; and
      6. 12) The signature of the principal investigator or organization official who is authorized to certify the application.