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City of Everett <br /> Washington State STOP Formula Grant Program Renewal Application for FFY 2019 <br /> APPLICATION CHECKLIST <br /> This checklist is to assist you in the completion of all application documents. Please include it with the <br /> submission of your application. <br /> APPLICATION DOCUMENTS COMPLETED <br /> Applicant Agency Information ✓ <br /> Budget: <br /> • Personnel <br /> o Salaries <br /> o Benefits <br /> o Subgrantees <br /> • Consultants <br /> • Goods and Services <br /> • Indirect Costs and any applicable documentation: <br /> o Approved rate agreement or certification <br /> o Indirect cost rate proposal <br /> o MTDC Certification form <br /> • Match or Cost Sharing Requirements and Total Budget Summary <br /> Civil Rights and Non-Discrimination Compliance ✓ <br /> Online Civil Rights Training ✓ <br /> Consultation with Victim Services Providers <br /> (Criminal Justice Applicants Only) ✓ <br /> Certification of Compliance with the Statutory Eligibility Requirements of the <br /> Violence Against Women Act as Amended, STOP Formula Grant Program ✓ <br /> (Criminal Justice Applicants Only) <br /> Acknowledgement of Notice of Statutory Requirement to Comply with the <br /> Confidentiality and Privacy Provisions of the Violence Against Women Act, as <br /> Amended ✓ <br /> (Victim Services Providers Only) <br /> Confidentiality and Personally Identifying Information <br /> (Victim Services Providers Only) ✓ <br /> Coordinated Community Response Team Participation <br /> ©The form is included in my application ✓ <br /> ❑The form is included in the application of: <br /> 28 <br />