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Instructions <br /> You may complete this form manually or electronically. Print the information if you opt to do this <br /> manually. Once you are finished, you have three options for submitting the application form to the <br /> Minnesota Department of Health: <br /> Option 1- Mail the form to: <br /> Minnesota Department of Health <br /> SWP Grant Coordinator <br /> P.O. Box 64975 <br /> St. Paul, Minnesota 55164-0975 <br /> Option 2- Fax the form to: <br /> SWP Grant Coordinator <br /> (651) 201-4701 <br /> Option 3- E-mail the form to: <br /> health.swpgrants@state.mn.us <br /> Attention: SWP Grant Coordinator <br /> Definitions of the Terms Used In This Form (In the Order Encountered) <br /> Public Water System Name means the name that is used by the Minnesota Department of Health to <br /> identify the public water system and that is associated with a public water supply system identification <br /> number. <br /> Name of the Grant Contact means the name of the individual who will be responsible for managing the <br /> grant. <br /> Telephone Number means the telephone number of the contact person that the Minnesota Department <br /> of Health can call during its regular business hours (M-F from 8:30 a.m.to 4:30 p.m.). <br /> E-mail means an internet address for the contact person that the Minnesota Department of Health can use <br /> to electronically transmit information related to the grant. <br /> Mailing Address means the mailing address of the public water system that shall be used for <br /> correspondence with MDH. <br /> Name and Title of the Person Authorized to Sign the Grant Agreement on Behalf of the Public Water <br /> System means a person who has authority to administer a financial agreement between the public water <br /> system and the Minnesota Department of Health. <br /> Total Grant Amount Being Requested means the sum of the costs of the work items that are identified in <br /> the grant application (1a + 2a +3a +....) <br /> Work Item is the source water protection activity measure from the WHP plan that are to be performed <br /> under this part of the grant application. Fill one box for each activity included in the project;feel free to <br /> insert more boxes if needed. <br /> Amount requested for performing this work means the estimated amount requested by the grantee for <br /> completing the activity performed under this part of the application. <br /> Product(s) produced or anticipated outcomes of performing this work means the tangible results of <br /> performing the work that is funded by this grant. <br /> 95 <br />