COPS Application

COPS Application
Attachment to SF-424

2

COPS Application Attachment to SF-424

OMB Control Number: 1103-0
Expiration Date: 02/29/2016

SECTION 1: COPS Office PROGRAM REQUEST
Federal assistance is being requested under the following COPS program:
Verify the COPS Office grant program for which you are requesting federal assistance. A separate application must
be completed for each COPS Office program for which you are applying. Please ensure that you read, understand,
and agree to comply with the applicable grant terms and conditions as outlined in the COPS Application Guide before
finalizing your selection.
ONLY ONE PROGRAM OPTION MAY BE CHECKED
Child Sexual Predator Program

Secure Our Schools
□

COPS Anti Gang Initiative

□ COPS Hiring Program
COPS Anti-Methamphetamine Program
COPS Anti-Heroin Task Force Program
Community Policing Development

CPD applicants please select a CPD topic areas from a drop down menu:
(1) Microgrants Initiative;
(2) Critical Response Technical Assistance;
(3) COPS Office Community Policing Demonstration Sites;
(4) Catalyst Awards

A. Non-Competitive/Invited Designation
A1) Have you been provided an invitational code by the COPS Office?
A2) If so, please enter your invitation code here:
B. Research & Development (R&D) Designation
B1) Could any portion of your project be considered research and development (R&D)) as defined by 2
C.F.R. §200.87?

SECTION 2: AGENCY ELIGIBILITY INFORMATION
Type of Agency (select one)
Non-Law Enforcement
Law Enforcement
From the list below, please select the type of agency which best describes the applicant.
Law Enforcement Entities

Select One...

Non-Law Enforcement Entities Select One...

3

2A. CHP Eligibility Questions
In this section, we will ask you several questions about your law enforcement agency operations and authority to
determine your eligibility to apply for a COPS Hiring Program (CHP) grant. Please note that CHP applicants must
have a police department which is operational as of the (mm/dd/yyyy) date of this application, or receive services
through a new or existing contract for law enforcement services. Applicants must also maintain primary law
enforcement authority for the population to be served.
Additionally, if funds under this program are to be used as part of a written contracting arrangement for law
enforcement services (e.g., a town which contracts with a neighboring sheriff's department to receive services), the
government agency wishing to receive law enforcement services must be the legal applicant in this application
(although we will ask you to supply some information about the contract service provider later).
Part I. Law Enforcement Agency Operations
A law enforcement agency is established and operational if the jurisdiction has passed authorizing legislation and it
has a current operating budget.
Q1) Is your agency established and currently operational?
Select One...

Q2) Which of the following best describes your agency (check one)?
We are planning to establish or begin operations as a newly authorized law enforcement agency
If selected, proceed to Q3a and Q3b
We are planning to re-establish and resume operations for a previously operational law enforcement agency
If selected, proceed to Q3b
Q3a) Has your jurisdiction passed legislation which authorizes the creation of a new law enforcement agency?
Select One...

Q3b) Will your law enforcement agency be operational as of mm/dd/yyyy (application close date)?
Select One...

Part II. Contracting to Receive Law Enforcement Services
Q1) If awarded, does your agency plan to use funds awarded under this grant to establish or supplement a written
contract for law enforcement services (e.g., a town contracting for services with a nearby sheriff's department)?
Select One...

[If yes to Q1, text below plus Q2 will display]

An agency may apply for funds under this program to be used as part of a written contracting arrangement for law
enforcement services (e.g., a town which contracts with a neighboring sheriff's department to receive services).
However, the agency wishing to receive law enforcement services must be the legal applicant in this application
(although we will ask you to supply some information about the contract service provider later).
Before proceeding with this application, we ask that you please log onto the COPS Agency Portal to update the
agency providing law enforcement services as your Law Enforcement Executive/Agency Executive Information.
This information will be pre-populated from the COPS Agency Portal in Section 4 of this application, so please
ensure its accuracy.
Important Note: Two entities involved in a contracting relationship may not separately apply for funding to support
the same officer position(s). For more information about contracting arrangements, please click here [Link to take

4

applicant to Guide Instructions re: contracting]
Q2) Is the legal applicant listed in this COPS Hiring Program (CHP) application and on the SF-424 the entity that
will be receiving law enforcement services?
Select One...

5

Q3) What is the legal name of the law enforcement agency that will be providing law enforcement services to your
jurisdiction?

[proceed to next section]

Part III. Law Enforcement Agency Authority
An agency with primary law enforcement authority is defined as the first responder to calls for service for all types of
criminal incidents within its jurisdiction. Agencies are not considered to have primary law enforcement authority if
they only: respond to or investigate specific type(s) of crime(s); respond to or investigate crimes within a
correctional institution; serve warrants; provide courthouse security; transport prisoners; and/or have cases
referred to them for investigation or investigational support.
Q1) Based on the definition above, does your agency have primary law enforcement authority? [Or, if contracting to
receive services, does the agency that will be providing law enforcement services have primary law enforcement
authority for the population to be served?]
Select One...

Questions for a subset of applicants [Sheriff, County Police, State Police, Regional PD, Public University, Private
University, Natural Resources Police, Transit Police, Public Housing Police, Attorney/Court, Multijurisdictional
Task Force, Consortium, Constable, Marshals, Corrections]
Is your agency the first responder to all types of criminal incidents within your jurisdiction?
Select One...

Agencies with jurisdiction limited only to correctional institutes and/or courthouse settings are not eligible under this
program. Is your agency the first responder to citizen-initiated calls for service outside of a correctional institute
and/or courthouse setting?
Select One...

2B: SOS Eligibility Questions
[All SOS Applicants]
1. Was this grant application prepared after consultation with individuals not limited to law enforcement officers
(such as school violence researchers, child psychologists, social workers, teachers, principals, and other school
personnel)?
Yes

No

2. Was this application prepared in a manner consistent with a comprehensive approach to preventing school violence?
Yes

No

3. Was this application individualized to the needs of each school at which those improvements are to be made?
Yes

No

4. Does your agency have primary law enforcement authority for the schools/school districts targeted through this grant
proposal?

6
Yes

No

5. Are the schools/school districts targeted through this grant proposal all public primary or secondary
schools (i.e., kindergarten through 12th grade)?
Yes

No

6. Do these schools all teach the basic school curriculum (e.g., math, science, reading)?
Yes

No

7. Will the funds awarded solely benefit the public primary or secondary schools targeted through this grant proposal?
Yes

No

[Subset 1 Municipal Police/County Police/Sheriff’s/State Police Agency, Tribal Police etc.
(any agency other than school district police department and university/college)]
8. Is your agency partnering with a school/school district?
Yes

No

[Subset 2 School District Police]
8. Is your agency a school district which, through authorization by its state and/or local legislative authority, has its
own police department separate from the local sheriff’s, county police, or municipal police agency?
Yes

No

[Subset 3 Public or Private University/College Police]
8. Is your agency a university or college which has a public primary or secondary school on its campus?
Yes

No

2C. CAMP Eligibility Questions
1. Is your agency a State Law Enforcement Agency authorized by law or by a state agency to engage in or to supervise
anti-methamphetamine investigative activities, such as locating and investigating illicit activities, precursor diversion,
laboratories and/or methamphetamine traffickers? (See Application Guide for more information on antimethamphetamine investigation authority.)

2. Can your agency provide state level data for calendar years <> regarding seizures of precursor
chemical, seizures of finished methamphetamine, seizures of methamphetamine laboratory, and laboratory dump seizure
rates?

2D. CAGI Eligibility Questions
This section will contain 1-5 questions to be answered by applicants under the COPS Anti-Gang Initiative.
Sample Question:

7
2E: AHTF Eligibility Questions
This section will contain 1-5 questions to be answered by applicants under COPS Heroin Program.
Sample Question: Are you a State law enforcement agency (Yes/No).SECTION

3: GENERAL AGENCY

INFORMATION
A. Applicant ORI Number:
The ORI number is assigned by the FBI and is your agency's unique identifier. The COPS Office uses the first seven
characters of this number. The first two letters are your state abbreviation, the next three numbers are your county's
code, and the next two numbers identify your jurisdiction within your county. If you do not currently have an ORI
number, the COPS Office will assign one to your agency for the purpose of tracking your grant. ORI numbers
assigned to agencies by the COPS Office may end in “ZZ.”
Check here if your agency has not been assigned an ORI number.
B. Applicant Data Universal Numbering System (DUNS) Number:
A Data Universal Numbering System (DUNS) number is required prior to submitting this application. A DUNS
number is a unique nine or thirteen digit sequence recognized as the universal standard for identifying and keeping
track of entities receiving federal funds. For more information about how to obtain a DUNS number, please refer to
the "How to Apply" section of the COPS Application Guide.
C. System for Award Management (SAM)
The System for Award Management (SAM) replaces the Central Contractor Registration (CCR) database as the
repository for standard information about federal financial assistance applicants, recipients, and sub-recipients.
DOJ requires that all applicants (other than individuals) for federal assistance maintain current registrations in the
SAM database. Please note that applicants must update or renew their SAM registration at least once a year to
maintain an active status.
Applicants that were previously registered in the CCR database must, at a minimum:
 Create a SAM account
 Log into SAM and migrate permissions to the SAM account (all the entity registrations and records from CCR
should already have been migrated).
Applicants that were not previously registered in the CCR database must register in SAM prior to registering in
Grants.gov. Information about SAM Registration procedures can be accessed at www.sam.gov.
For more information about how to register with SAM, please refer to the “How to Apply” section of the COPS
Application Guide.
Your SAM Registration is set to expire on
Note: If your SAM registration is set to expire prior to September 30, 2015, please renew your SAM Registration prior to completing this application. Contact
the SAM Service Desk at 866-606-8220 or view/update your registration information at www.sam.gov.

D. Geographic Names Information System (GNIS) ID:

8

Please enter your Geographic Names Information System (GNIS) Identification Number. This is a unique ID assigned
to all geographic entities by the U.S. Geological Survey. To look up your GNIS Feature ID, please go to the website:
http://geonames.usgs.gov/domestic/index.html. For more information about how to obtain a GNIS number, please refer
to the “How to Apply” section of the COPS Application Guide.

9

E. Cognizant Federal Agency: Select One...
Select the legal applicant’s Cognizant Federal Agency. A Cognizant Federal Agency, generally, is the federal agency
from which your jurisdiction receives the most federal funding. Your Cognizant Federal Agency also may have been
previously designated by the Office of Management and Budget. Applicants that have never received federal funding
should select the “Department of Justice” as the Cognizant Federal Agency.
F. Fiscal Year:

to

(mm/dd)

ORI#

Standard Application Forms

Enter the month and day of the legal applicant's fiscal year.
G. Law Enforcement Agency Sworn Force Information
1. Enter the Fiscal Year Budgeted Sworn Force Strength for the current fiscal year below. The budgeted number of
sworn officer positions is the number of sworn positions funded in your agency’s budget, including funded but frozen
positions, as well as state, Bureau of Indian Affairs, and/or locally funded vacancies. Do not include unfunded
vacancies or unpaid/reserve officers.
a. Number of officers funded in agency’s current fiscal year budget:
Full-Time:

Part-Time:

H. Civilian Staffing
1. Number of civilian positions funded in agency's current fiscal year budget:
a. Number of civilian positions funded in agency’s current fiscal year budget:
Full-Time:

Part-Time:

(Civilians/(Civilians + Officers))

%

I. U.S. Department of Justice and Other Federal Funding
Applicants are required to disclose whether they have pending applications for federally funded assistance or active federal grants
that support the same or similar activities or services for which grant funding is being requested under this application.

Be advised that as a general rule COPS grant funding may not be used for the same item or service funded through another funding
source. However, leveraging multiple funding sources in a complementary manner to implement comprehensive programs or
projects is encouraged and is not seen as inappropriate. To aid the COPS Office in the prevention of awarding potentially
duplicative funding, please indicate whether your agency has a pending application and/or an active grant with any other federal
funding source (e.g. direct federal funding or indirect federal funding through State sub-awarded federal funds) which supports the
same or similar activities or services as being proposed in this COPS application check all that apply):

Pending Application
Bureau of Justice Assistance (BJA)
Office of Justice Programs (OJP)
Office of Juvenile Justice and Delinquency Prevention
(OJJDP)
Office on Violence Against Women (OVW)
National Institute of Justice (NIJ)
Office for Victims of Crime (OVC)
Other Department of Justice Funding
Other Federal or State Sub-awarded Funding

Active Grant

ORI#

Standard Application Forms

No Federal or State Sub-awarded Funding

Please specify the other Federal or State sub-awarded funding source(s)

ORI#

Standard Application Forms

SECTION 4: EXECUTIVE INFORMATION
Note: Listing individuals without ultimate programmatic and financial authority for the grant could delay the review of
your application, or remove your application from consideration.
A. Law Enforcement Executive/Agency Executive Information:
For Law Enforcement Agencies: This is the highest ranking law enforcement official within your jurisdiction
(e.g., Chief of Police, Sheriff, or equivalent). The section below has been pre-populated from the information listed
in your COPS Office Agency Portal Account. If this information is no longer correct, please log in to your COPS
Office Agency Portal account and make the necessary corrections before proceeding with this application. For
assistance, please call the COPS Office Response Center at 800.421.6770.
For Non-Law Enforcement Agencies:
This is the highest ranking individual in the applicant agency (e.g., CEO, President, Chairperson, or Director) who
has the authority to apply for this grant on behalf of the applicant agency. If the grant is awarded, this position would
ultimately be responsible for the programmatic implementation of the award. The section below has been prepopulated from the information listed in your COPS Office Agency Portal Account. If this information is no longer
correct, please log in to your COPS Office Agency Portal account and make the
necessary corrections before proceeding with this application. For assistance, please call the COPS Office Response
Center at 800.421.6770.
[Displayed If Contracting Law Enforcement Services]

Your agency previously indicated that if awarded, this grant would be used in a written contracting arrangement to
receive law enforcement services (e.g., a town which is contracting with a neighboring sheriff’s department to receive
services). Therefore, for question 4A, please provide the executive information for the agency which will be providing
the law enforcement services under this grant (e.g., Sheriff). For question 4B, please provide executive information for
the government agency which will be receiving the law enforcement services under this grant (i.e., Mayor, City
Manager, etc.). Before proceeding with this application, we ask that you please log onto the COPS Office Agency
Portal to update the agency providing law enforcement services as your Law Enforcement Executive/Agency Executive
Information. This information will be used to populate Section 4 of this application, so please ensure its accuracy.
Interim/Acting:

Title: Select One...
First Name:

MI

Last Name:

Suffix:

Agency Name:
Street Address 1:
Street Address 2:
City:
Telephone:

State:
Fax:

Zip Code:

E-mail:

B. Government Executive/Financial Official Information:
For Government Agencies:
This is the highest ranking government official within your jurisdiction (e.g., Mayor, City Administrator, or
equivalent). The section below has been pre-populated from the information
listed in your COPS Office Agency Portal Account. If this information is no longer correct, please log in to your
COPS Office Agency Portal account and make the necessary corrections before proceeding with this
application. For assistance, please call the COPS Office Response Center at 800.421.6770.
For Non-Government Agencies:

ORI#

Standard Application Forms

This is the financial official who has the authority to apply for this grant on behalf of the applicant agency (e.g.,
CFO or Treasurer). If the grant is awarded, this position would ultimately be responsible for the financial
management of the award. Please note that information for non-executive positions (e.g., clerks or trustees) is not
acceptable. This section below has been pre-populated from the information listed in your COPS Office Agency
Portal Account. If this information is no longer correct, please log in to your COPS Office Agency Portal account
and make the necessary corrections before proceeding with this application. For assistance, please call the COPS
Office Response Center at 800.421.6770.
Title: Select One...
First Name:

Interim/Acting:
MI:

Last Name:

Suffix:

Agency Name:
Street Address 1:
Street Address 2:
City:

State:

Zip Code:

ORI#

Standard Application Forms

Telephone:

Fax:

E-mail:

ORI#

Standard Application Forms

C. Application Contact Information:
Application Contact: Enter the application contact's name and contact information.
Title: Select One...

Interim/Acting:

First Name:

MI:

Last Name:

Suffix:

Agency Name:
Street Address 1:
Street Address 2:
City:
Telephone:

State:
Fax:

E-mail:

Zip Code:

ORI#

Standard Application Forms

[Section 5A below only applies if CHP is the selected program]

SECTION 5A: COPS HIRING PROGRAM OFFICER REQUEST
Part I
Enter the Fiscal Year Actual Sworn Force Strength as of the date of this application. The actual number of sworn
officer positions is the actual number of sworn positions employed by your agency as of the date of this application.
Do not include funded but currently vacant positions or unpaid positions.
a. Number of officers employed by your agency as of the date of this application:
Full-Time:

Part-Time:

[If contracting, only question below is displayed]
1. Enter the Fiscal Year Actual Sworn Force Strength for officers your agency currently has under contract for law
enforcement services as of the date of this application. The actual number of sworn officer positions is the actual
number of sworn officers under all current contracts as of the date of this application. Do not include funded but
currently vacant positions or unpaid positions.
a. Number of officers deployed by your agency as of the date of this application:
Full-Time:

Part-Time:

What is the actual population your department serves as the primary law enforcement entity?
This may or may not be the same as your census population. For example, a service population may be the census
population minus incorporated towns and cities that have their own police department within your geographic
boundaries or estimates of ridership (e.g., transit police) or visitors (e.g., park police). An agency with primary law
enforcement authority is defined as having first responder responsibility to calls for service for all types of criminal
incidents within its jurisdiction.
For FY2015, COPS Hiring Program (CHP) applicants are eligible to apply for the number of officers equal to 5 percent
of their actual sworn force strength up to a maximum of 25 officers. Agencies with a sworn force of twenty or fewer
officers may apply for one (1) officer position. Agencies with a service population of 1 million or above may apply for
up to 25 officer positions; however, agencies with a service population less than 1 million may apply for up to 15 officer
positions. Based on the information provided in this application, your agency is eligible to apply for up to
<> officer position(s).
FY 2015 CHP grant funds cover 75 percent of the approved entry-level salary and fringe benefits of each newly-hired
and/or rehired, full-time sworn career law enforcement officer for three years (36 months) up to $125,000 per officer
position. CHP grant funding will be based on your agency's current entry-level salaries and fringe benefits for fulltime sworn officers.
If your agency requests officers to be deployed as School Resource Officers, ALL OF THE OFFICER POSITIONS
REQUESTED BELOW MUST BE USED TO DEPLOY FULL-TIME SCHOOL RESOURCE OFFICERS. Do not
request more officer positions than your agency can expect to deploy in this capacity. A “school resource officer” is a
career law enforcement officer, with sworn authority, who is engaged in community policing activities and is assigned by
the employing agency to work in collaboration with schools. If awarded a grant for SRO position(s), please note that the
COPS Office requires that the officer(s) deployed into the SRO position(s) spend a minimum of 75 percent of their time in
and around primary and secondary schools working on school and youth-related activities.

ORI#

Standard Application Forms

The placement of law enforcement officers in school carries a risk of contributing to a “school-to-prison pipeline” process
where students are arrested or cited for minor, non-violent behavioral violations and then diverted to the juvenile court
system. This pipeline wastes community resources and can lead to academic failure and greater recidivism rates for these
students. If awarded, the grantee agrees that any officers deployed while implementing the COPS School Resource Officer
under the COPS Hiring Grant cannot be involved in the discipline of the students. There must be an increase in the level of
community policing activities performed in and around primary or secondary school in the agency’s jurisdiction as a result of
the grant. The time commitment of the funded officers must be above and beyond the amount of time that the agency
devoted to the schools before receiving the grant.
Grantees using CHP funding to hire and/or deploy School Resource Officers into schools agree that a signed Memorandum of
Understanding (MOU) between the law enforcement agency and the school partner(s) must be submitted to the COPS Office
before obligating or drawing down funds under this award. An MOU is not required at time of application; however, if the law
enforcement agency already has an MOU in place that is applicable to the partnership, the MOU can be submitted as an attachment
in Section 13 of the grant application. The MOU must contain the following; the purpose of the MOU, clearly defined officer roles and
responsibilities on campus, focus officers’ roles on safety, provide proper training and monitoring of the program’s activities, including
data collection and evaluation, information sharing, supervision responsibility and chain of command for the SRO and signatures.
Grantee agrees that the MOU must be submitted and accepted by the COPS Office 90 days from the date on your award
congratulatory letter. The implementation of the COPS Hiring Grant without submission and acceptance of the required MOU within
the 90 day timeframe may result in expenditures not being reimbursed by the COPS Office.

Is your agency requesting that all of these officer positions be deployed as School Resource Officers (SROs)?
Yes

No

In addition, in section 6B you must select “School Based Policing through School Resource Officers” under “Child and
Youth Safety Problems” as your problem area.
How many entry-level, full-time officer positions is your agency requesting in this application?

Next, your agency must allocate the number of positions requested under each of the three hiring categories described
below based on your agency's current needs at the time of this application. Please be mindful of the initial three-year
grant period, and your agency's ability to fill and retain the officer positions awarded, while following your agency's
established hiring policies and procedures. CHP grant awards will be made for officer positions requested in each of
the three hiring categories, and grantees are required to use awarded funds for the specific categories awarded.
It is imperative that your agency understand that the COPS Office statutory nonsupplanting requirement mandates that
grant funds may only be used to supplement (increase) a grantee's law enforcement budget for sworn officer positions
and may not supplant (replace) state, local, or tribal funds that a grantee otherwise would have spent on officer
positions if it had not received a grant award. This means that if your agency plans to:
(a) Hire new officer positions (including filling existing vacancies that are no longer funded in your agency's budget):
It must hire these new additional positions on or after the official grant award start date, above its current budgeted
(funded) level of sworn officer positions, and otherwise comply with the nonsupplanting requirement as described in
detail in the Grant Owner’s Manual.
(b) Rehire officers who have been laid off by any jurisdiction as a result of state, local, or tribal budget cuts: It must
rehire the officers on or after the official grant award start date, maintain documentation showing the date(s) that the
positions were laid off and rehired, and otherwise comply with the nonsupplanting requirement as described in detail
in the Grant Owner’s Manual.
(c) Rehire officers who are (at the time of application) currently scheduled to be laid off (by your jurisdiction) on a
specific future date as a result of state, local, or tribal budget cuts: It must continue to fund the officers with its own
funds from the grant award start date until the date of the scheduled lay-off (for example, if the CHP award start date
is September 1 and the lay-offs are scheduled for November 1, then the CHP funds may not be used to fund the
officers until November 1, the date of the scheduled lay-off); identify the number and date(s) of the scheduled layoff(s) in this application(see below); maintain documentation showing the date(s) and reason(s) for the lay-off; and
otherwise comply with the nonsupplanting requirement as described in detail in the Grant Owner’s Manual. [Please
note that as long as your agency can document the date that the lay-off(s) would occur if CHP funds were not
available, it may transfer the officers to the CHP funding on or immediately after the date of the lay-off without
formally completing the administrative steps associated with a lay-off for each individual officer.]
Documentation that may be used to prove that scheduled lay-offs are occurring for local economic reasons that are
unrelated to the availability of CHP grant funds may include (but are not limited to) council or departmental meeting
minutes, memoranda, notices, or orders discussing the lay-offs; notices provided to the individual officers regarding the
date(s) of the lay-offs; and/or budget documents ordering departmental and/or jurisdiction-wide budget cuts. These
records must be maintained with your agency’s CHP grant records during the grant period and for three years
following the official closeout of the CHP grant in the event of an audit, monitoring, or other evaluation of your grant
compliance.
If your agency's request is funded, your agency will have the opportunity after the award announcement to request a
grant modification to move awarded funding into the category or categories that meet your agency's law enforcement
needs at that time (including updating the dates of future scheduled lay-offs).
If you need additional information regarding requesting a modification, please contact the COPS Office Response
Center at 1.800.421.6770. ORI#
Standard Application Forms

Category A: New, additional officer positions (including to fill existing vacancies no longer funded in your agency’s
budget).

Category A Request: <>
Category B: Rehire officers laid off as a result of state or local budget reductions.

Category B Request: <>
Category C: Rehire officers scheduled to be laid off (at the time of the application) on a specific future date as a result
of state or local budget reductions.

Category C Request: <>

(total)

We also need some information about when the layoff of officers in this category is scheduled to
occur. In the space below, please indicate when the officer(s) specified in this category are
scheduled to be laid off.
Number of officers:
Date these officers are scheduled to be laid off:
Number of officers:
Date these officers are scheduled to be laid off:
Number of officers:
Date these officers are scheduled to be laid off:

16

Part 2 [Section hidden unless Category C in previous section not null]
Since your agency plans to use CHP funds to rehire officers who are currently scheduled to be laid off on a future date
(under Category C above), please certify (by checking the appropriate boxes) to the following:
Certification:
My agency has and will maintain documentation showing the date(s) of the scheduled lay-off(s) and
demonstrating that the scheduled lay-off(s) is/are occurring for fiscal reasons that are unrelated to the availability
or receipt of CHP grant funds.
My agency will use its own funds to continue funding these officers until the scheduled date(s) of the lay-off(s)
and will use CHP funds to rehire these officers only on or after the scheduled date of the lay-off(s).
My agency recognizes that the CHP program provides funding based on our entry-level salary and benefits
package and that any additional costs for rehired officers beyond entry-level are our responsibility to pay
with other sources of funding.
If an applicant receives an award, and needs to change the hiring categories after receiving the award, it must request a
post-award grant modification to change the categories of hiring and receive prior approval before spending CHP
funding by calling the COPS Office Response Center at 1.800.421.6770.

ORI#

Standard Application Forms

Part 3
As noted previously, the number of officers an applicant can request under the COPS Hiring Program in 2015 is
capped. However, the COPS Office is interested in learning more about the overall need for officer positions within
your department. Therefore, if no officer caps were in place, what is the total number of officers that your agency
would be requesting in this application?
Part 4
Under the 2015 COPS Hiring Program, applicants are not required to hire post-September 11, 2001 military veterans as
new hires. However, the COPS Office supports the Attorney General’s commitment to hiring military veterans whenever
possible. Please note that if your agency checks “yes” to the question below, your agency will be required to maintain
documentation that it made every effort possible (consistent with your internal procedures and policies) to hire at least one
military veteran.
Does your agency commit to hire and/or rehire at least one post-September 11, 2001 military veteran (as defined in the
Application Guide) for the officer position(s) you have requested?
Yes

No

If yes, how many officer position(s) from your total 2015 CHP request does your agency anticipate filling with postSeptember 11, 2001 military veterans?

[Section 5B below applies only if CSPP is the selected program]

SECTION 5B: CHILD SEXUAL PREDATOR PROGRAM (CSPP) OFFICER REQUEST
1. Is your agency requesting funding in this application for full-time, entry-level sworn officer positions?
Yes

No

2. How many full-time, entry-level sworn officer positions is your agency requesting in this application?

[Note: you will be asked in Section 14 to provide detailed entry-level officer salary and benefit costs]
17

ORI#

Standard Application Forms

Non-hiring Applicants Only

SECTION 6A: LAW ENFORCEMENT & COMMUNITY POLICING STRATEGY
COPS Office grants must be used to reorient the mission and activities of law enforcement agencies through initiating
community policing or enhancing their involvement in community policing. If awarded funds, your responses to this
section will constitute your agency’s community policing strategy under this grant. Your organization may be audited or
monitored to ensure that it is initiating or enhancing community policing in accordance with this strategy. The COPS
Office may also use this information to understand the needs of the field, and potentially provide for training, technical
assistance, problem solving and community policing implementation tools.
We understand that your community policing needs may change during the life of your grant (if awarded), and minor
changes to this strategy may be made without prior approval from the COPS Office. We also recognize that this
strategy may incorporate a broad range of possible community policing strategies and activities, and that your agency
may implement particular community policing approaches from the strategy on an as-needed basis throughout the life
of the grant. If your agency’s community policing strategy changes significantly, however, you must submit those
changes in writing to the COPS Office for approval. Changes are “significant” if they deviate from the range of
possible community policing activities identified and approved in this original community policing strategy submitted
with your application.

ORI#

Standard Application Forms

Community Policing Definition Framework
The following is the COPS Office definition of community policing that emphasizes the primary components of
community partnerships, organizational transformation, and problem solving.
Community policing is a philosophy that promotes organizational strategies, which support the systematic use of
partnerships and problem-solving techniques, to proactively address the immediate conditions that give rise to public
safety issues, such as crime, social disorder, and fear of crime.
The COPS Office has completed the development of a comprehensive community policing self-assessment tool for use
by law enforcement agencies. Based on this work, we have developed the following list of primary sub-elements of
community policing. Please refer to the COPS Office website (www.cops.usdoj.gov) for further information regarding
these sub-elements.
Community Partnerships:
Collaborative partnerships between the
law enforcement agency and the
individuals and organizations they serve
to both develop solutions to problems
and increase trust in police.

Organizational Transformation:
The alignment of organizational
management, structure, personnel and
information systems to support
community partnerships and proactive
problem-solving efforts.

Problem Solving:
The process of engaging in the proactive
and systematic examination of identified
problems to develop effective responses
that are rigorously evaluated.

Agency Management
Other Government Agencies

Climate and culture

Scanning: Identifying and prioritizing

Community Members/Groups

Leadership

Analysis: Analyzing problems

Non-Profits/Service Providers

Labor relations

Response: Responding to problems

Private Businesses

Decision-making

Media

Strategic planning

Assessment: Assessing problem-solving
initiatives

Policies
Organizational evaluations
Transparency
Organizational Structure
Geographic assignment of officers
Despecialization
Resources and finances
Personnel
Recruitment, hiring and selection
Personnel supervision/evaluations
Training
Information Systems (Technology)
Communication/access to data
Quality and accuracy of data

Using the Crime Triangle to focus on
immediate conditions (Victim/
Offender/Location)

ORI#

Standard Application Forms

Proposed Community Policing Strategy
COPS grants must be used to initiate or enhance community policing activities, either directly by your law
enforcement agency, or (for non-law enforcement applicants) in collaboration with law enforcement. Please complete
the following questions to describe the types of community policing activities that you are currently engaged in and
that will result from COPS funding. For each question, answer on behalf of the applicant law enforcement agency, or
for non-law enforcement applicants, the law enforcement agency with whom you will collaborate.
You may find more detailed information about community policing at the COPS Office website
http://www.cops.usdoj.gov/Default.asp?Item=36.
Community Partnerships
Community partnerships are ongoing collaborative relationships between law enforcement and the individuals and
organizations they serve to both develop solutions to problems and increase trust in the police.
My Agency:
P1) Regularly distributes relevant crime and disorder information to community members.
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

P2) Routinely seeks input from the community to identify and prioritize neighborhood problems (e.g., through
regularly scheduled community meetings, annual community surveys, etc.).
a

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

ORI#

Standard Application Forms

P3) Regularly collaborates with local government agencies that deliver public services.
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

P4) Regularly collaborates with non-profit organizations and/or community groups.
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

P5) Regularly collaborates with local businesses.
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

P6) Regularly collaborates with informal neighborhood groups and resident associations.
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

ORI#

Standard Application Forms

P7) Regularly collaborates with federal government agencies through formal partnerships (e.g., taskforces,
working groups, etc.).
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

Problem Solving
Problem solving is an analytical process for systematically (1) identifying and prioritizing problems, (2) analyzing
problems, (3) responding to problems, and (4) evaluating problem-solving initiatives. Problem solving involves an
agency-wide commitment to go beyond traditional police responses to crime to proactively address a multitude of
problems that adversely affect quality of life.
My Agency:
PS1) Routinely incorporates problem-solving principles into patrol work.
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

PS2) Identifies and prioritizes crime and disorder problems through the routine examination of patterns and
trends involving repeat victims, offenders, and locations.
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

ORI#

Standard Application Forms

PS3) Routinely explores the underlying factors and conditions that contribute to crime and disorder problems.
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

PS4) Systematically tailors responses to crime and disorder problems to address their underlying conditions.
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

PS5) Regularly conducts assessments to determine the effectiveness of responses to crime and disorder
problems.
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

ORI#

Standard Application Forms

Organizational Transformation
Organizational transformation is the alignment of organizational management, structure, personnel and information
systems to support community partnerships and proactive problem-solving efforts.
My Agency:
OT1) Incorporates community policing principles into the agency’s mission statement and strategic plan.
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

OT2) Practices community policing as an agency-wide effort involving all staff (i.e., not solely housed in a
specialized unit).
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

OT3) Incorporates problem-solving and partnership activities into personnel performance evaluations.
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

ORI#

Standard Application Forms

Technology
Technology provides agencies with the tools to communicate more effectively externally with the public and internally
with their own staff, and the ability to understand and analyze community problems.
My Agency:
TEC01) Ensures that agency staff have appropriate access to relevant data (e.g., calls for service, incident and
arrest data, etc.).
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

TEC02) Uses technology (e.g., crime mapping or statistical software) to analyze and understand problems in
the community.
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

TEC03) Uses technology (e.g., GIS/GPS for deployment or laptops for field reporting) to improve the agency’s
overall efficiency and effectiveness.
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

ORI#

Standard Application Forms

TEC04) Provides officers with necessary equipment to better prevent and/or respond to crime and disorder
problems.
a)

YES

If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO

b)

NO

If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO

Community Policing Strategy Narrative
Please describe your agency’s implementation strategy for this program (if awarded), with specific reference to each of
the following elements of community policing: (a) community partnerships and support, including consultation with
community groups, private agencies, and/or other public agencies; (b) related governmental and community initiatives
that complement your agency’s proposed use of COPS funding; and (c) organizational transformation – how your
agency will use these funds, if awarded, to reorient its mission to community policing or enhance its involvement in and
commitment to community policing.
In the space provided, please address your agency’s implementation strategy for this program with specific reference
to each of the following elements of community policing:
(a) Community partnerships and support, including consultation with community groups, private agencies,
and/or other public agencies.
[Responses are limited to a maximum of 5,000 characters.]

(b) Related governmental and community initiatives that complement your agency’s proposed use of COPS
funding.
[Responses are limited to a maximum of 5,000 characters.]

ORI#

Standard Application Forms

(c) Organizational transformation – how your agency will use these funds, if awarded, to reorient its mission
to community policing or enhance its involvement in and commitment to community policing.
[Responses are limited to a maximum of 5,000 characters.]

CP1) To what extent is there community support in your jurisdiction for implementing the proposed grant
activities?
a) High level of support
b) Moderate support
c) Minimal support

CP2) If awarded, to what extent will the grant activities impact the other components of the criminal justice
system in your jurisdiction?
a) Potentially decreased burden
b) No change in burden
c) Potentially increased burden

ORI#

Standard Application Forms

SECTION 6B: LAW ENFORCEMENT & COMMUNITY POLICING STRATEGY
CHP Applicants Only

Community Policing Strategy
COPS Office grants must be used to reorient the mission and activities of law enforcement agencies through initiating
community policing or enhancing their involvement in community policing with the officers hired under this grant
program, or an equal number of veteran officers who have been redeployed to implement this plan after hiring the
entry-level COPS-funded officers. If awarded funds, your responses to sections II(a) and II(b) that follow will
constitute your agency’s community policing strategy under this grant. Your organization may be audited or monitored
to ensure that it is initiating or enhancing community policing in accordance with this strategy. The COPS Office may
also use this information to understand the needs of the field, and potentially provide for training, technical assistance,
problem solving and community policing implementation tools. Please note that the COPS Office recognizes that your
COPS-funded officer(s) (or an equal number of veteran officers who are redeployed after hiring the entry-level COPSfunded officers) will engage in a variety of community policing activities and approaches, including participating in
some or all aspects of your identified community policing strategy. Your community policing strategy may be
influenced and impacted by others within and outside of your organization; this is considered beneficial to your
community policing efforts.
At any time during your grant, you should be prepared to demonstrate (1) the community policing activities engaged in
prior to the grant award that are detailed in section I of this application and (2) how the grant funds and grant-funded
officers (or an equal number of redeployed veteran officers) were specifically used to enhance (increase) or initiate
community policing activities according to your community policing strategy contained in sections II(a) and II(b) of this
application.
Finally, we also understand that your community policing needs may change during the life of your grant. Minor
changes to this strategy may be made without prior approval of the COPS Office; however, grantees will be
required to report on progress and/or changes to the community policing strategy (if any) through required
progress reports. If your agency’s community policing strategy changes significantly, you must submit those changes
to the COPS Office for approval. Changes are “significant” if they deviate from the specific crime problems(s)
originally identified and approved in the community policing strategy submitted with the application. In some cases,
changes to the approved community policing approaches may also be deemed significant and may require approval of a
modified community policing strategy by the COPS Office, depending on the scope and nature of those changes as
identified in the quarterly progress reports.

ORI#

Standard Application Forms

Community Policing Definition Framework
The following is the COPS Office definition of community policing that emphasizes the primary components of
community partnerships, organizational transformation, and problem solving. Please refer to the COPS Office website
(www.cops.usdoj.gov) for further information regarding this definition.
Community policing is a philosophy that promotes organizational strategies, which support the systematic use of
partnerships and problem-solving techniques, to proactively address the immediate conditions that give rise to public
safety issues, such as crime, social disorder, and fear of crime.
The COPS Office has completed the development of a comprehensive community policing self-assessment tool for use
by law enforcement agencies. Based on this work, we have developed the following list of primary sub-elements of
community policing. Please refer to the COPS Office website (www.cops.usdoj.gov) for further information regarding
these sub-elements.
Community Partnerships:

Organizational Transformation:

Problem Solving:

Collaborative partnerships between the
law enforcement agency and the
individuals and organizations they serve
to both develop solutions to problems
and increase trust in police.

The alignment of organizational
management, structure, personnel and
information systems to support
community partnerships and proactive
problem-solving efforts.

The process of engaging in the proactive
and systematic examination of identified
problems to develop effective responses
that are rigorously evaluated.

Agency Management
Other Government Agencies
Community Members/Groups
Non-Profits/Service Providers
Private Businesses
Media

Climate and culture
Leadership Labor
relations Decisionmaking Strategic
planning Policies
Organizational evaluations
Transparency

Organizational Structure
Geographic assignment of officers
Despecialization
Resources and finances

Personnel
Recruitment, hiring and selection
Personnel supervision/evaluations
Training

Information Systems (Technology)
Communication/access to data
Quality and accuracy of data

Scanning: Identifying and prioritizing
problems
Analysis: Analyzing problems
Response: Responding to problems
Assessment: Assessing problem-solving
initiatives
Using the Crime Triangle to focus on
immediate conditions (Victim/Offender/
Location)

ORI#

Standard Application Forms

I. Current Organizational Commitment to Community Policing
1) For each of the following statements, please answer in terms of existing agency policies and practices as they
relate to collaborative partnerships and problem solving activities (please check all that apply).
Activity

Community Partnerships

Problem Solving

Q1a. The agency mission statement, vision, and/or
goals includes references to:
Q1b. The agency strategic plan includes specific
goals and/or objectives relating to:
Q1c. The agency recruitment, selection and hiring
processes include elements relating to:
Q1d. Annual line officers valuations assess
performance in:
Q1e. Line officers receive regular (at least once
every two years) training in:

2) Which of the following internal management practices does your agency currently employ?
Assignment of officers to specific neighborhoods or areas for longer periods of time to enhance customer service and facilitate
more contact between police and citizens
Assignment of officers to geographic hot spots that are defined statistically by creating incident maps to identify geographic
clustering of crime or disorder
In-service training for officers on basic and advanced community policing principles
Early Intervention Systems that help identify officers who may be showing signs of stress, personal problem, and questionable
work conduct
Alternatives to formal disciplinary practices that encourage ethical behavior
None of the above

3) Which of the following do you count/measure to annually assess your agency’s overall performance (please
check all that apply):
Response times
Reported crimes
Reported incidents
Arrests and citations
Problem solving outcomes
Department employee satisfaction
Clearance rates
Complaints of officer behavior
Reduction of crime in identified hot spots
Repeat calls for service
Social disorder/nuisance problems (e.g. graffiti, panhandling, loitering, etc.)
Satisfaction with police services

ORI#

Standard Application Forms

Fear of crime
Victimization (i.e. non-reported crime)
Community meetings held/attended
Use of force incidents
Meeting the priorities as identified in your agency strategic plan
My agency does not conduct annual assessments of overall performance

ORI#

Standard Application Forms

4) Through which of the following does your agency routinely share information with community members (please
check all that apply):
Neighborhood, beat, and/or school meetings
Local media outlets
Agency newsletter
Neighborhood newsletters
Agency website
Social networking (Blogs, Twitter feeds, Facebook pages, etc.)
Citizen alert system (telephone, email, text, etc.)
Citizen alert system that is geographically targeted, based on
updated hot spots
Public access television/radio
Community organization board membership
Public forums with Chief/Sheriff/Command staff
Posters, billboards, flyers
None of the above

5) Through which of the following ways does your agency formally involve community members in influencing
agency practices and operations (please check all that apply):
Citizen police academies
Volunteer activities
Auxiliary police programs
Civilian review boards (e.g. disciplinary review boards)
Citizen advisory groups (i.e. informal advisory function)
Involvement in hiring decisions (i.e. interview panels, selection boards, etc.)
Involvement in contributing to annual line officer performance reviews
Representation on promotional boards
Participation in accountability and performance reporting and tracking meetings
Participation in complaint resolution process (i.e. formal mediation, disciplinary boards, etc.)
None of the above

ORI#

Standard Application Forms

II(a) Proposed Community Policing Strategy: Problem Solving and Partnerships
COPS grants must be used to initiate or enhance community policing activities with either the newly-hired officers
funded by this grant program, or an equivalent number of veteran officers who are redeployed to implement this
community policing plan after hiring the additional entry-level officers with COPS grant funds. In this section you will
be asked to identify the crime and disorder problem and the partners to be engaged through your requested COPS
funding. Identifying the specific problem and partnerships that your agency plans to focus on is important to ensure
that you satisfy the requirements for COPS funding under this program and to ensure that ultimately the additional
grant-funded officers (or equivalent number of redeployed veteran officers) will initiate or enhance your agency’s
capacity to implement community policing approaches.
6) Using the following list, select a problem that will be addressed by the officers requested in this application.
Please choose the option that best fits your problem. You may select one problem to address through this grant
funding.
When identifying a problem, it is important to think about the nature of similar incidents that taken together
comprise the problem, and accordingly describe it in precise, specific terms (e.g. “burglary of retail
establishments”, rather than just “burglary”). In doing this, it can be helpful to consider all aspects of the problem,
including the likely offenders, the suitable targets/victims, and how these come together in time and space.
Child and Youth Safety Problems
Child Sexual Predators and Internet Safety
Please specify your child sexual predator problem; for example, non-compliant sexual offenders, trafficking in
children, child sexual abuse offenses, cyber-related crimes, etc.
School Based Policing through School Resource Officers
By selecting this problem your agency is committing that, if awarded, all officer positions requested in this application
(or the equivalent number of redeployed veteran officers) will be used to deploy School Resource Officers and address
problems in and around primary and secondary schools. The placement of law enforcement officers in school carries a
risk of contributing to a “school-to-prison pipeline” process where students are arrested or cited for minor, non-violent
behavioral violations and then diverted to the juvenile court system. This pipeline wastes community resources and can
lead to academic failure and greater recidivism rates for these students. Any officers deployed while implementing the
COPS School Resource Officer under the COPS Hiring Grant cannot be involved in the discipline of the students.
Grantees using CHP funding to hire and/or deploy School Resource Officers into schools agree that a signed Memorandum of
Understanding (MOU) between the law enforcement agency and the school partner(s) must be submitted to the COPS Office
before obligating or drawing down funds under this award. An MOU is not required at time of application; however, if the law
enforcement agency already has an MOU in place that is applicable to the partnership, the MOU can be submitted as an
attachment in Section 13 of the grant application. The MOU must contain the following; the purpose of the MOU, clearly defined
officer roles and responsibilities on campus, focus officers’ roles on safety, provide proper training and monitoring of the program’s
activities, including data collection and evaluation, information sharing, supervision responsibility and chain of command for the
SRO and signatures. Grantee agrees that the MOU must be submitted and accepted by the COPS Office 90 days from the date on
your award congratulatory letter. The implementation of the COPS Hiring Grant without submission and acceptance of the required
MOU within the 90 day timeframe may result in expenditures not being reimbursed by the COPS Office.

ORI#

Standard Application Forms

Please specify the areas the School Resource Officer(s) would address (check all that apply):
□ to address crime and problems, gangs, and drug activities affecting or occurring in or around an elementary or
secondary school;
□ to develop or expand crime prevention efforts for students;
□ to educate youth in crime prevention and safety;
□ to develop or expand community justice initiatives for students;
□ to train students in conflict resolution, restorative justice, and crime awareness;
□ to assist in the identification of physical changes in the environment that may reduce crime in or around the
school; and
□ to assist in developing school policy that addresses crime and to recommend procedural changes to enhance
school safety.

ORI#

Standard Application Forms

Children Exposed to Violence
Please specify your children exposed to violence problem; for example, children’s reactions to domestic violence;
witnessing community violence; exposure to catastrophic events; etc.
Youth Crime and Delinquency
Please specify your youth crime and delinquency problem; for example, teen gang activity, bullying, truancy,
loitering in public places, etc.
Other Child and Youth Safety Problem (please specify)
Drug Related Problems
Drug Manufacturing/Trafficking
Please specify your drug manufacturing/trafficking problem; for example, clandestine methamphetamine labs,
drug trafficking across international borders, marijuana growing operations etc.
Drug Dealing
Please specify your drug dealing problem; for example, drug dealing in open air markets, drug dealing in
apartment complexes, gang related drug dealing
Drug Abuse
Please specify your drug abuse problem; for example, underage drinking, prescription drug abuse, drug abuse by
prostitutes etc.
Other Drug Related Problem (please specify)
Homeland Security Problems
Protecting Critical Infrastructure Problems
Please specify your critical infrastructure problem; for example, addressing threats against facilities, developing
and testing incident response plans, etc.
Information or Intelligence Problems
Please specify your information and/or intelligence problem; for example, the need for criminal intelligence
capacity, engaging in information sharing, expanding utilization of fusion centers, etc.
Other Homeland Security Problem (please specify)
Non-Violent Crime Problems
Burglary
Please specify your burglary problem; for example, burglary of single family houses, burglary of retail
establishments, burglary of construction sites etc.
Fraud

ORI#

Standard Application Forms

Please specify your fraud problem; for example, check fraud, identity theft, credit card fraud, fraud of the elderly,
etc.
Larceny/Theft (Non-Motor Vehicle)
Please specify your larceny/theft problem; for example, shoplifting, pickpocketing, etc.
Motor Vehicle Theft/Theft from Motor Vehicle
Please specify your motor vehicle theft problem/theft from motor vehicle; for example, organized motor vehicle
theft, joy riding, theft of motor vehicles from parking garages, theft from motor vehicle in targeted area, etc.
Vandalism
Please specify your vandalism problem; for example, graffiti, vandalism of public parks, tagging, etc.
Social Disorder
Please specify your disorder problem; for example, disorder in public places, disorder at day laborer sites,
disorder on school grounds, etc.
Quality of Life Problem
Please specify your quality of life problem; for example, abandoned vehicles, panhandling, fear of crime, vacant
properties, etc.
Prostitution
Please specify your prostitution problem; for example, street prostitution, organized prostitution, etc.
Other Non-Violent Crime Problem (please specify)

ORI#

Standard Application Forms

Trust Problems
Fair and Impartial Problems
Please specify your bias policing problems; for example: racial profiling, disparate contact, lack of programs for
racial reconciliation, etc.
Problems with Transparency
Please specify your transparency problem; for example: lack of education for community on police operations,
lack of civilian review programs
Problems with Fairness and Respect
Please specify your fairness and respect problem; for example: lack of programs to address immigrant
communities, addressing the needs of persons with mental illness, victims, lack of programs for restorative
justice
Other Trust Problem (please specify)

ORI#

Standard Application Forms

Traffic/Pedestrian Safety Problems
Traffic Congestion
Please specify your traffic congestion problem; for example, traffic congestion around schools, traffic congestion
due to special events, traffic congestion during peak hours, etc.
Pedestrian Safety
Please specify your pedestrian safety problem; for example, pedestrian safety during night time hours, pedestrian
safety around schools, pedestrian safety at crosswalks, pedestrian traffic on roadways, etc.
Driver Safety
Please specify your driver safety problem; for example, driving under the influence, speeding in residential areas,
street racing, distracted driving, etc.
Traffic Accidents
Please specify your traffic accident problem; for example, traffic accidents by commercial drivers, traffic
accidents in residential areas, traffic accidents by young drivers, etc.
Other Traffic/Pedestrian Safety Problem (please specify)
Violent Crime Problems
Assault
Please specify your assault problem; for example, assaults in and around bars, gang violence, etc.

Homicide
Please specify your homicide problem; for example, gun homicide by serious previous offenders, gang related
homicide, domestic homicides, etc.
Rape
Please specify your rape problem; for example, acquaintance rape, rape in college dorm rooms, child or domestic
rape, etc.
Robbery
Please specify your robbery problem; for example, robbery of convenience stores, robbery of taxi drivers, bank
robbery, etc.
Domestic/Family Violence
Please specify your domestic/family violence problem; for example, domestic violence, stalking, child abuse,
elder abuse, etc.

ORI#

Standard Application Forms

Gun Violence
Please specify your gun violence problem; for example, gun violence by juvenile gang members, drug related
gun violence, etc.
Please also include the number of aggravated assaults with a firearm in your jurisdiction during the last
calendar year:
Other Violent Crime Problem (please specify)

ORI#

Standard Application Forms

Please answer questions 6a thru 11 for each problem identified
6a) Briefly describe the problem that you will address with these grant funds and your approach to the
problem. [4,000 characters or less]

ORI#

Standard Application Forms

6b) Will the problem described above be addressed with an explicit place-based strategy (e.g., hot-spot
policing) that targets specific addresses or locations with a disproportionate share of crime or disorder?
Yes

No

6c) Which of the following activities will your agency and officers hired under this grant (or an equivalent
number of redeployed veteran officers) engage in as it pertains to your identified crime hot spot? (please
check all that apply):
Enhance enforcement efforts (sweeps or increased patrol
Targeted community alerts
Prevention efforts directed at high-risk victims
Prevention efforts directed at high-risk offenders
On-going identification of crime concentrations by qualified analysts
Formal evaluation of the effectiveness of interventions (e.g., using pre/post-test and/or comparison groups)

7) Which of the following information sources did you use to prioritize this problem as a problem to address
through this grant program (please check all that apply):
Police department data (e.g. police reports, calls for service, crime data, citizen complaints)
Agency personnel (e.g. officer feedback, command staff priorities)
Other local non law enforcement government agency data
Community based organizations (e.g. faith based, non-profits, social service providers)
Local businesses
Individual community members/community meetings
Community survey
Local government officials
The media
None of the above

8) If awarded funds, my agency will improve our understanding of this problem by examining (please check all
that apply):
Routinely collected law enforcement data/information related to the problem (e.g. arrest, incident reports, calls for service)
The location and/or time aspects of the problem (e.g. mapping)
The conditions and environmental factors related to the problem
The strengths and limitations of current responses to the problem
Non-law enforcement data/information related to the problem (e.g. insurance crash data, other government agency data, census
data, survey data)
Existing research and best practices related to the problem
Data/information from the community related to the problem (e.g. resident associations, business groups, non-profit
community service organizations)
Information about offenders contributing to the problem (e.g. offender interviews, arrest records)
Information about victims affected by the problem (e.g. crime reports, victim interviews)
Strengths and weaknesses of previous responses to the problem
None of the above

9) If awarded funds my agency will use the following information sources to assess our response to this problem to
determine whether the response was implemented and achieved the desired outcomes (please check all that apply):
Routinely collected law enforcement data/information related to the problem (e.g. crime data, arrests, incident reports,
calls for service)
Data/information regarding whether the response was implemented as planned
Police data collected for this specific problem (e.g. problem-specific surveys, field interview contact cards, etc.)
Non-police data/information related to the problem (e.g. insurance crash data, other government agency data, census
data, survey data)
Data/information from the community related to the problem (e.g. resident associations, business groups, non-profit
community service organizations)

ORI#

Standard Application Forms

Information about offenders contributing to the problem (e.g. offender interviews, arrest records, probation/parole data)
Information about victims and/or stake holders affected by the problem (e.g. crime reports, victim interviews)
None of the above

10) To the best of your ability at this time, would you say your primary goal(s) in responding to <> include which of the following (please select up to 3):
Eliminating the problem
Reducing the number of incidents
Increasing public trust in your agency
Reducing the seriousness of the incidents or the amount of harm
Reducing the number of victims and/or repeat victims
Reducing the number of offenders and/or repeat offenders
Moving the problem to another area
Getting other agencies and/or stake holders to assume responsibility for the problem
Improving the response to the problem (i.e., more comprehensive and coordinated way of dealing with the problem,
providing better services to victims, or greater efficiency in dealing with the problem)
Improving citizen perceptions of the problem
Increasing the number of arrests/citations
Reducing the number of calls for service
None of the above

11) An important part of a comprehensive community policing strategy is the formation of partnerships, such as
working with other public agencies, private organizations, or participation in regional law enforcement partnerships. If
awarded funds, will your agency and the grant-funded officers (or an equivalent number of redeployed veteran
officers) initiate or enhance a partnership with an external group/organization to develop
responses to this problem?
Yes

No

[If Yes go to 11a, If No go to 12]

11a) If awarded funds, how many external groups/organizations will your agency initiate or enhance a
partnership with to develop responses to this problem?

11b) Name the most important external groups/organizations that your agency will initiate or enhance a
partnership with to develop responses to this problem (maximum of three partners). Note: you may attach
optional letters of this support from any or all of these prospective partners in Section 13 of the application. You
will be limited to listing no more than three partners per public safety problem.
Partner 1
Partner 2
Partner 3

ORI#

Standard Application Forms

[ASK FOR EACH PARTNER IDENTIFIED]
11c) For this partner, please indicate the statement that best characterizes this partner:
Local government agencies (non-law enforcement, e.g. probation/parole, parks and recreation, code enforcement, etc.)
Community based organizations (e.g. faith based, community redevelopment groups, social service providers,
resident associations)
Businesses operating in the community
Tribal law enforcement agencies [if selected, question 11d will be asked]
Federal, state, or local law enforcement agencies (non-tribal) including through multi-jurisdictional/regional
Local educational institutions (schools/colleges/universities)
Individual stake holders (persons residing, working, or with an interest in the community or problem)

11d) For your Tribal law enforcement agency partner, please indicate if you have a formalized MOU/MOA signed
by both partners which governs partnership activities, roles, and responsibilities::
□ Yes
□ No
established shared ownership and responsibility
co-committed resources (financial, staffing, etc.)
established processes and/or systems to share relevant data
conduct routine meetings at the operational or strategic level to plan and implement responses
conduct joint training and planning exercises

ORI#

Standard Application Forms

Questions are no longer problem specific; please answer the following questions once per respondent.

II(b) Proposed Community Policing Strategy: Organizational Transformation
COPS grants must be used to initiate or enhance community policing activities. In this section you will be asked to
identify the organizational change(s) that your agency plans to focus on through your requested COPS funding.
Identifying the specific organizational change(s) that your agency plans to focus on is important to ensure that you
satisfy the requirements for COPS funding under this program, and to ensure that ultimately the use of these funds will
initiate or enhance your agency’s capacity to implement community policing approaches.
12) If awarded funds, will your agency initiate or enhance any of the following internal changes to personnel
management? (Select no more than 2 internal changes to personnel management that will be addressed with these
grant funds.)
Flexibility in officer shift assignments to facilitate addressing specific problems
Assignment of officers to specific neighborhoods or areas for longer periods of time to enhance customer service and
facilitate more contact between police and citizens
Recruitment and hiring practices that reflect an orientation towards problem solving and community engagement
In-service training for officers on basic and advanced community policing principles
Field training officer (FTO) programs that teach and test problem solving, community engagement, and critical thinking
skills
Personnel evaluation systems that assess officer activities, accomplishments, and performance related to problem solving
and community engagement
Early intervention systems that help identify officers who may be showing early signs of stress, personal problems, and
questionable work conduct
First-line supervisory skills to support officer problem solving and community engagement activities
Career development and/or promotional processes that reinforce problem solving and community engagement
None of the above

13a) Briefly describe each specific internal personnel management change or enhancement that you identified
above that you will address with these grant funds. [2,000 characters or less]
Please provide a narrative for each internal change to personnel management identified.

13) If awarded funds, will your agency initiate or enhance any of the following internal changes to agency
management? (Select up to 2 internal changes to agency management that will be addressed with these grant funds.)
Agency mission statement, vision, and/or goals that reflect the core values of community policing
Agency strategic plan that outlines the goals and objectives around community policing and other departmental priorities
Organizational performance measurement systems that include community policing metrics, and conduct annual
assessments of agency performance
Technology systems that provide officers, analysts, and the community better and more timely access to data and
information
Mediation strategies to resolve citizen complaints
Collection, analysis, and use of crime data and information in support of problem solving goals
Formal accreditation process
System to capture and track problem solving and partnership efforts and activities
An organizational assessment of community policing
Level and frequency of communication with the community on crime problems and agency activities to enhance
transparency
None of the above

ORI#

Standard Application Forms

13a) Briefly describe each internal agency management change or enhancement that you identified above that
you will address with these grant funds [2,000 characters or less]
Please provide a narrative for each internal change to agency management identified.

III. General Community Support and Engagement
14) Did your agency consult with any of the following groups/organizations on the development of this community
policing strategy? (please check all that apply)
Local government agencies (non-law enforcement, e.g. probation/parole, parks and recreation, code enforcement, etc.)
Community based organizations (e.g. faith based, community redevelopment groups, social service providers, resident
associations)
Businesses operating in the community
Tribal law enforcement agencies (outside your jurisdiction)
Other Federal, state, or local law enforcement agencies
Multi-jurisdictional or regional task forces/partnerships
Local educational institutions (schools/colleges/universities)
Local government officials
Individual stakeholders residing, working or with an interest in the community and/or problem
None of the above

15) To what extent are there related governmental and/or community initiatives that complement your agency’s
proposed community policing strategy?
a) There are a significant number of related initiatives
b) There are a moderate number of related initiatives
c) There are a minimal number of related initiatives
d) There are no related initiatives

16) To what extent is there community support in your jurisdiction for implementing the proposed community
policing strategy?
a) High level of support
b) Moderate level of support
c) Minimum level of support

17) If awarded funds, to what extent will the community policing strategy impact the other components of the
criminal justice system in your jurisdiction?
a) Potentially decreased burden
b) No change in burden
c) Potentially increased burden

ORI#

Standard Application Forms

SECTION 7: NEED FOR FEDERAL ASSISTANCE

A. Explanation of Need for Federal Assistance
All applicants are required to explain their inability to address the need for this award without federal assistance. Please
do so in the space below.
[Please limit your responses to a maximum of 3,000 characters.]

B. Service Population
1. Enter the total population of the government entity applying for this grant using the latest census estimate available
in the American Fact Finder at http://FactFinder.census.gov.

2. Check here if the population of the entity applying for this grant is not represented by U.S. Census figures (e.g.,
[If checked, complete 2a – 2b.]
colleges, special agencies, school police departments, etc.).
2a. If the population of the entity applying for this grant is not represented by U.S. Census figures, please indicate the
size of the population as of the latest available estimate:
2b. Please indicate the source of this population estimate:
(e.g., website address)
3. What is the actual population your department serves as the primary law enforcement entity?
This may or may not be the same as the population specified above. For example, a service population may be the
census population minus incorporated towns and cities that have their own police department within your geographic
boundaries or estimates of ridership (e.g., transit police) or visitors (e.g., park police). An agency with primary law
enforcement authority is defined as having first responder responsibility to calls for service for all types of criminal
incidents within its jurisdiction.
[This number should be pre-populated from Section 5A]

3a. If applicable, please explain why the service population differs from the census population:

C. Fiscal Health
Note: If your application involves a contract for law enforcement services please refer to the instructions regarding contracting arrangements
found in Section 7: Fiscal Health of the Application Guide before completing this section.

1) Enter your law enforcement agency’s total operating budget for the current AND previous two fiscal years.
Please note: All figures must be rounded to the nearest whole dollar.
CURRENT FISCAL YEAR (<>) $
PREVIOUS FISCAL YEAR (<>) $
PREVIOUS FISCAL YEAR (<>) $

3) The U.S. Census Bureau American Community Survey (ACS) provides multi-year poverty rate estimates for
communities. Please go to the U.S. Census Bureau’s American FactFinder (http://FactFinder.census.gov) to
determine the percentage of families in poverty in your jurisdiction based on the 2005 - 2009 ACS. For
jurisdictions not included in the census (e.g., schools, universities, transit, parks), please check the box for “Not
Applicable.” Please see the program Application Guide for additional information and help in using the American
FactFinder. Please note: All figures must be rounded to the nearest whole percent.
Percentage of families in poverty

%

Not Applicable
4) The Bureau of Labor Statistics’ Local Area Unemployment Statistics (LAUS) program provides monthly
estimates of unemployment for communities. Please go to the Bureau of Labor Statistics’ LAUS website
(www.bls.gov/lau/data.htm) to find detailed instructions for looking up your local area’s unemployment rate. It
may be necessary to select the nearest best match to your jurisdiction (for example, a city of fewer than 25,000 people
may report their county level rate). Please see the program Application Guide for additional information and help in
using the LAUS data. For jurisdictions not included in the census (e.g., schools, universities, transit, parks), please
check the box for “Not Applicable.” Please note: All figures must be rounded to the nearest whole percent.
Percentage unemployed for <>

%

Not Applicable
5) Indicate if your jurisdiction has experienced any of the following events since <>:
(Check all that apply)
A declaration of natural or other major disaster or emergency has been made pursuant to the Robert T. Stafford Disaster
Relief and Emergency Assistance Act. (42 U.S.C. 5121 et seq.)
A declaration as an economically or financially distressed area by the state in which the applicant is located.
Downgrading of the applicant’s bond rating by a major rating agency.
Has filed for or been declared bankrupt by a court of law.
Has been placed in receivership or its functional equivalent by the state or federal government.
Taken on additional law enforcement duties and responsibilities resulting from an agency merger or the disbanding of a
neighboring law enforcement agency (which did not result in a new or supplemented funded contract to provide these law
enforcement services)

6) In addition to the data collected elsewhere in this application, the COPS Office would like to capture information from
jurisdictions that may have faced unanticipated catastrophic event that has a significant impact on the delivery of law enforcement
services since <>. Examples of events include school shootings, terrorist attacks, natural disasters, or other events
leading to mass casualties that would not necessarily be reflected in the UCR crime statistics previously reported. Events that
require additional community policing resources and could be evaluated as a case study for advancing community policing
responses to specific catastrophic events or unique significant crime-related problems in other jurisdictions around the country will
be reviewed and may be considered in the overall scoring of the application and/or the eligibility for a local match waiver (in the
case of unanticipated economic impact). Please note that if your jurisdiction is faced with an unanticipated catastrophic event
(e.g., school shooting, terrorist attack, other mass casualty event) after submission of this application, you should contact the COPS
Office immediately, before the solicitation closing date, at <> to update your application to include this
information.
If your agency has experienced an unanticipated catastrophic event in the last 12 months, check this box <>

If box is checked, provide these instructions:
You indicated that your jurisdiction has experienced an unanticipated catastrophic event. You must submit a narrative description
of the catastrophic event with as much detail as possible. Please address the following:


Description of Event (including number of casualties)



Type of Event (natural disaster, multiple casualty shooting, bombing, unique crime-related problem, etc)



Impact of the Event on Delivery of Law Enforcement Services



Duration of the Event (how long will law enforcement services be impacted by the event until recovery)



Law Enforcement Response and Recovery Efforts

Please attach a narrative with the above information in Section 13 of this application. Attachment must be in Microsoft Word or
Adobe PDF format.

7) The Promise Zone Initiative is part of the President’s plan to create a better bargain for the middle-class by partnering

with local communities and businesses to create jobs, increase economic security, expand educational opportunities,
increase access to quality, affordable housing and improve public safety. In exchange, these designees will receive the
resources and flexibility they need to achieve their goals. The designees have agreed to and must demonstrate a
collaborative effort- between private business and federal, state, tribal and local officials; faith-based and non-profit
organizations; children and parents- to ensure that hard work leads to a decent living for every American, in every
community.
To be a Promise Zone, your <> must have been designated as such by <>.
Is your agency within the jurisdiction of a designated Promise Zone?

Yes/No

D. Property/Violent Crime
Please select at least one statement below:
□

My agency can report crime data for all 3 years (please input in table below).

□

My agency cannot report crime data for 2014.

□

My agency cannot report crime data for 2013.

□

My agency cannot report crime data for 2012.

1) Using UCR crime definitions, enter the actual number of incidents reported to your agency in the previous
three calendar years <> for the following crime types. Note that only those incidents for which
your agency had primary response authority should be provided.
UCR Data *

<>

<>

<>

Criminal Homicide
Forcible Rape
Robbery
Aggravated Assault
Burglary
Larceny (except motor vehicle theft)
Motor Vehicle Theft
Please note: Only those incidents for which your agency had primary response authority should be provided. An agency with primary response authority is
defined as the first responder to calls for service for all types of criminal incidents within its jurisdiction. Agencies are not considered to have primary response
authority if they only: respond to or investigate a specific type(s) of crime(s); respond to or investigate crimes within a correctional facility; serve warrants;
provide courthouse security; transport prisoners; and/or have cases referred to them for investigation or investigational support.
*Note: If your agency currently reports to NIBRS, or does not report crime incident totals at all, please ensure that your data is converted to UCR Summary
Data style. Please see the COPS Application Guide or the FBI’s UCR Handbook (www.fbi.gov/ucr/handbook/ucrhandbook04.pdf) for more information.

SECTION 8: CONTINUATION OF PROJECT AFTER FEDERAL FUNDING ENDS
If you are applying for a COPS grant with a post-award retention requirement, please complete A. If you are
applying for a COPS grant without a post-award retention requirement, please complete B.

A. Continuation of Project after Federal Funding Ends (for COPS grants with a retention
plan requirement)
Applicants must plan to retain all sworn officer positions awarded under your COPS hiring grant for a minimum of
12 months at the conclusion of 36 months of federal funding for each position. The retained COPS funded positions
should be added to your agency’ law enforcement budget with state and/or local funds at the end of grant funding,
over and above the number of locally-funded sworn officer positions that would have existed in the absence of the
grant. These additional position(s) must be retained using state, local, or other non-federal funding only. You may
not use funds awarded by other federal grants to cover the costs of retention. At the time of grant application,
applicants must affirm that they plan to retain the positions and identify the planned source(s) of retention funding.
We understand that your agency’ source(s) of retention funding may change during the life of the grant. Your agency
should maintain proper documentation of any changes in the event of an audit, monitoring or other evaluation of
your grant compliance. Please refer to the frequently asked questions on retention which can be found here
http://www.cops.usdoj.gov/Default.asp?Item=2364.
1. Will your agency plan to retain any additional positions awarded under this grant for a minimum of 12
months at the conclusion of federal funding for each position?
YES

NO

Note: Agencies that do not plan to retain all the positions awarded under this grant are ineligible to receive CHP funding

2. Please identify the source(s) of funding that your agency plans to utilize to cover the costs of retention:
(check all that apply)
General funds
Raise bond/tax issue
Private sources/donations
Non-federal asset forfeiture funds (subject to approval from the state or local oversight agency)
Fundraising efforts
State, local, or other non-federal grant funding
Other (Please provide a brief description of the source(s) of funding not to exceed 500 characters.)

B. Continuation of Project after Federal Funding Ends (for other COPS grants with no
retention plan requirement)
Please complete these questions to indicate any plans you may have to continue this program, project, or activity after
the conclusion of federal funding.
1. Does your agency plan to obtain necessary support and continue the program, project, or activity
following the conclusion of federal support?
YES

NO

2. Please identify the source(s) of funding that your agency plans to utilize to continue the program, project,
or activity following the conclusion of federal support: (check all that apply)
General funds
Raise bond/tax issue
Private sources/donations
Non-federal asset forfeiture funds (subject to approval from the state or local oversight agency)
Fundraising efforts
State, local, or other non-federal grant funding
Other (Please provide a brief description of the source(s) of funding not to exceed 500 characters.)

SECTION 9: SCHOOL SAFETY ASSESSMENT
SOS Applicants Only

Agencies that have conducted a school safety assessment within the last three years must answer questions about the
assessment conducted. If your agency has not conducted a school safety assessment within the last three years, your
agency will be asked to complete one as a requirement for grant funding. Funding may be requested through this grant
application to conduct the school safety assessment. You will also be required to answer questions that will focus on
the assessment that will be conducted during the grant implementation period. Please note, your agency may request
other allowable items and is not limited to solely funding a school safety assessment.
Has your agency completed an assessment within the last three years?

Select One...

APPLICANTS WHICH HAVE CONDUCTED SCHOOL SAFETY ASSESSMENTS WITHIN THE LAST THREE YEARS (Questions 1-5)

1. When was the assessment completed?
2. Who conducted the assessment? Identify ALL internal and external parties involved.
Teachers
Students
Parents
Community Stakeholders

School Security/Safety Personnel
Consultants
School Administrators
Other

3. Identify what aspects of school safety and security were assessed. Select all that apply:
Security and Surveillance Systems
Building Access Control
Classroom Security
Student and Teacher Handbooks
Emergency Communications
Safety and Security of School Grounds

School Code of Conduct
Crisis Plans
School Incident and Discipline Data
Evaluation of Site Access Control Systems
Indoor/Outdoor Athletic Facilities located on School Grounds
Other

4. Did the assessment include any staff, teacher, student, or parent survey data related to school climate?
Yes

No

If yes, please describe the survey instrument your agency used. Answers are limited to 2000 characters.

5. What were the findings of the assessment? Specifically outline the school based problems identified. Please
note: All budget items requested must be justified in your budget narrative as a result of these findings of
the assessment. Answers are limited to 2000 characters.

ORI#

Standard Application Forms
APPLICANTS WHICH HAVE NOT CONDUCTED SCHOOL SAFETY ASSESSMENTS WITHIN THE LAST THREE YEARS (Questions 6-11)

6. When do you plan to complete the assessment?
The School Safety Assessment MUST be conducted within the grant implementation period.
7. Will your agency request funding through this grant application to conduct a school safety assessment?
Yes

No

If your agency answered no, please explain your response. Answers are limited to 1000 characters.

8. Who do you plan to include in your assessment? Identify ALL internal and external parties that may be
involved. Select all that apply:
Teachers
Students
Parents
Community Stakeholders
Local Business

Law Enforcement/ Safety Personnel
Consultants
School Administrators
Other

9. Identify what aspects of preventing school violence that you intend to assess. Select all that apply:
Security and Surveillance Systems
Building Access Control
Classroom Security
Student and Teacher Handbook
Emergency Communications
Safety and Security of School Grounds

School Code of Conduct
Crisis Plans
School Incident and Discipline Data
Evaluation of Site Access Control Systems
Indoor/Outdoor Athletic Facilities located on School Grounds
Other

10. Does your agency plan to include any staff, teacher, student, or parent survey data related to school climate?
Yes

No

If yes, please describe the survey instrument your agency plans to use. Answers are limited to 1000 characters.

11. Specifically identify any preliminary results of the school based problems and the source of the findings.
Answers are limited to 2,000 characters.

SECTION 10: EXECUTIVE SUMMARY
Please provide a brief summary of how your agency will use this federal funding. Refer to the COPS Application
Guide for clarification on specific information to include in your summary, and be sure to provide a description of how
you expect this grant to impact public safety and/or crime prevention in your community. The Executive Summary
may be used to keep Congress or other executive branch agencies informed on law enforcement strategies to deter
crime in your community.
[Responses are limited to a maximum of 3,000 characters.]

SECTION 11: PROJECT DESCRIPTION (NARRATIVE)
Please include in your application an in-depth narrative response detailing your proposed project. Please refer to the
COPS Application Guide: "How to Apply" for information on what should be included in your response, as well as any
additional formatting requirements and page length limitations. Note: Community Policing Development (CPD),
COPS Anti-Methamphetamine Program (CAMP), COPS Anti-Gang Initiative (CAGI), and COPS Anti-Heroin
Task Force Program (AHTF) grant applicants must submit their entire project description as an attachment in
Section 13 of this application.
A. Problem Identification

[Responses are limited to a maximum of 4,000 characters.]

B. Project Goals/Objectives

[Responses are limited to a maximum of 4,000 characters.]

C. Building Relationships and Solving Problems

[Responses are limited to a maximum of 4,000 characters.]

D. Implementation Plan

[Responses are limited to a maximum of 4,000 characters.]

E. Evaluation Plan/Effectiveness of Program

[Responses are limited to a maximum of 4,000 characters.]

F. Project Description (Narrative) Attachment:
Community Policing Development (CPD), COPS Anti-Methamphetamine Program (CAMP), COPS Anti-Gang
Initiative (CAGI), and COPS Anti-Heroin Task Force Program (AHTF) applicants must submit their entire project
description as an attachment in Section 13 of this application.

SECTION 12: OFFICIAL PARTNER(S) CONTACT INFORMATION
An official "partner" under the grant may be a governmental, private, school district, or other applicable entity that has
established a legal, contractual, or other agreement with the applicant for the purpose of supporting and working
together for mutual benefits of the grant. Please see the COPS Application Guide for more information on official
partners that may be required.
Title:
First Name:

MI:

Last Name:

Name of Partner Agency (e.g., Smithville High School):
Type of Partner Agency (e.g., School District):
Street Address 1:
Street Address 2:
City:

State: Zip Code: Telephone:
Fax:

E-mail:
Click here to add additional partners.

Suffix:

SECTION 13: APPLICATION ATTACHMENTS
This section should be used to attach any required or applicable attachments to your grant application (e.g.,
Memorandum of Understanding, etc.).
To complete the CAMP Project and Budget Narratives, applicants must follow this link to obtain the required fillable
forms: [link]. Once completed, both the CAMP Project Narrative Form and the CAMP Budget Narrative Form must be
saved and uploaded to Section 13 using the appropriate titles in the drop down menu below. Additional information is
also provided in the CAMP Application Guide.
Sample Language for CAGI
To complete the CAGI Project and Budget Narratives, applicants must follow this link to obtain the required fillable
forms: [link]. Once completed, both the CAGI Project Narrative Form and the CAGI Budget Narrative Form must be
saved and uploaded to Section 13 using the appropriate titles in the drop down menu below. Additional information is
also provided in the CAGI Application Guide.
Sample Language for AHTF
To complete the AHTF Project and Budget Narratives, applicants must follow this link to obtain the required
fillable forms: [link]. Once completed, both the AHTF Project Narrative Form and the AHTF Budget
Narrative Form must be saved and uploaded to Section 13 using the appropriate titles in the drop down menu
below. Additional information is also provided in the AHTF Application Guide.

A Memorandum of Understanding (MOU) is required under the COPS Hiring Program grant for applicants that select the
School Pased Policing through School Resource Officers problem area. This document must be submitted to the COPS
Office before obligating or drawing down funds, if awarded. An MOU is not required at time of application; however, if the law
enforcement agency already has an MOU in place that is applicable to the partnership, the MOU can be submitted as an
attachment in this section of the grant application. The MOU must contain the following; the purpose of the MOU, clearly defined
officer roles and responsibilities on campus, focus officers’ roles on safety, provide proper training and monitoring of the program’s
activities, including data collection and evaluation, information sharing, supervision responsibility and chain of command for the
SRO and signatures. If awarded, the grantee agrees that the MOU must be submitted and accepted by the COPS Office 90 days
from the date on your award congratulatory letter. The implementation of the COPS Hiring Grant without submission and
acceptance of the required MOU within the 90 day timeframe may result in expenditures not being reimbursed by the COPS Office.

Please refer to the program-specific Application Guide to determine if an MOU or other application attachments are
required. The Guide will also specify if optional attachments are permitted for submission.
ADD ATTACHMENTS
<< Uploaded Attachment 1 Name >>

Select One...

<< Uploaded Attachment 2 Name >>

Select One...

SECTION 14: BUDGET DETAIL WORKSHEETS
Instructions for Completing the Budget Detail Worksheets
The following Budget Detail Worksheets are designed to allow all COPS grant and cooperative agreement applicants
to use the same budget forms to request funding. Allowable and unallowable costs vary widely and depend upon the
type of COPS program. The maximum federal funds that can be requested and the federal/local share breakdown
requirements also vary.
Please refer to the program-specific Application Guide to determine the allowable/unallowable costs, the maximum
amount of federal funds that can be requested, and the federal/local share requirements for the COPS program for
which your agency is applying. To assist you, sample Budget Detail Worksheets are included in each Application
Guide.
Please complete each section of the Budget Detail Worksheets applicable to the program for which you are applying
(see the program-specific Application Guide for requirements). If you are not requesting anything under a particular
budget category, please check the appropriate box in that category indicating that no positions or items are requested.
All calculations should be rounded to the nearest whole dollar. Once the budget for your proposal has been completed,
a budget summary page will reflect the total amounts requested in each category, the total project costs, and the total
federal and local shares.
If you need assistance in completing the Budget Detail Worksheets, please call the COPS Office Response
Center at 800-421-6770.

1.

How many new entry-level, full-time officer positions, not currently funded in your agency(s) local budget, are
your agency requesting in this application?
If your agency is not requesting funding for new entry-level, full-time officer positions in this application, please
insert a zero in the response box. Please note you should not account for requests for officer overtime here.

A. SWORN OFFICER POSITIONS

No Sworn Officer Positions Requested

Instructions: This worksheet will assist your agency in reporting your agency’s current entry-level salary and benefits
and identifying the total salary and benefits request per officer position for the length of the grant term. Please list the
current entry-level base salary and fringe benefits rounded to the nearest whole dollar for one full-time sworn officer
position within your agency. Do not include employee contributions. (Please refer to the program-specific Application
Guide for information on the length of the grant term for the program under which you are applying.)
Special note regarding sworn officer fringe benefits: For agencies that do not include fringe benefits as part of the
base salary costs and typically calculate these separately, the allowable expenditures may be included under Part 1,
Section B. Any fringe benefits that are already included as part of the agency’s base salary (Part 1, Section A of the
Sworn Officer Budget Worksheet) should not also be included in the separate fringe listing (Part 1, Section B).
Please refer to the program-specific Application Guide for information about allowable and unallowable fringe
benefits for sworn officer positions requested under the program to which your agency is applying.

Standard Application Forms

ORI#

A. Full-Time Entry-Level Sworn Officer Base Salary Information
No Sworn Officer Positions Requested
Part 1: Instructions: Please complete the questions below based on your agency’s entry-level salary and benefits package for one locally-funded officer position. As applicable per the programspecific Application Guide, you may also be required to project Year 2 and Year 3 salaries. To learn more about what types of officer fringe benefit costs are allowable, please click here
A. Base Salary Information

Year 1 Salary
Enter the current first year entrylevel base salary for one sworn
officer position.

Year 2 Salary (As applicable)
Enter the second year base salary
for one entry-level sworn officer
position.

Year 3 Salary (As applicable)

$

$

$

Enter the third year base salary for
one entry-level sworn officer
position.

B. Fringe benefit costs should be calculated for each year of the grant term.
FRINGE BENEFITS:
Social Security

Year 2 Fringe Benefits

Year 1 Fringe Benefits
COST:

Exempt:

% OF BASE

COST:

Year 3 Fringe Benefits

% OF BASE

COST:

% OF BASE

Fixed Rate:

$

%

$

%

$

%

Fixed Rate:

$

%

$

%

$

%

:

$

%

$

%

$

%

Fixed Rate:

$

%

$

%

$

%

6.2%

Cannot exceed 6.2% of Total Base Salary.

Exempt:

Medicare

1.45%

Cannot exceed 1.45% of Total Base Salary.

Health Insurance
Family:
Life Insurance
Vacation

Number of Hours Annually:

$

%

$

%

$

%

Sick Leave

Number of Hours Annually:

$

%

$

%

$

%

Fixed Rate:

$

%

$

%

$

%

Exempt:

Fixed Rate:

$

%

$

%

$

%

Unemployment Insurance Exempt:

Fixed Rate:

Retirement
Worker’s Compensation

$

%

$

%

$

%

Other Select One...

$

%

$

%

$

%

Other Select One...

$

%

$

%

$

%

Other Select One...

$

%

$

%

$

%

Benefits Sub-Total Per Year (1 Position)

$

$

$

C. Total Year Salary and Benefits (1 Position):

$

$

$

D. Total Salary and Benefits for Years 1, 2, and 3 (1 Position): $

X

# of Positions =

$

ORI#

Standard Application Forms

Part 2: Sworn Officer Salary Information
If your agency's second and/or third-year costs for salaries and/or fringe benefits increase after the first year,
check the reason(s) why in the space below:
Cost of living adjustment (COLA)

Step raises

Change in benefit costs

Part 3: Federal/Local Share Costs (for Hiring Grants)
As part of the local matching requirement for the 2015 COPS Hiring Program, grantees must assume a progressively larger
share of the cost of the grant with local funds over the three‐year grant period. This means that your local match must
increase each year, while the federal share must decrease.

Total Salary and Benefits for
year 1, 2, & 3 (all positions):

Actual amount pre-populated
from the budget

Total Federal Share:

Actual amount pre-populated
from the budget

Percentage pre-populated from
the budget

Total local share required
(sworn officer costs):

Actual amount pre-populated
from the budget

Percentage pre-populated from
the budget

Please project in the chart below how your agency plans to assume a progressively larger share of the grant costs during
each year of the program. The chart is only a projection of your plans; while your agency may deviate from these specific
projections during the grant period, it must still ensure that the federal share decreases and the local share increases. For
more details on local matching requirements for this program, please refer to the program‐specific Application Guide.

Percent of the “Total Local Share Required” your agency plans to assume in Year 1
Percent of the “Total Local Share Required” your agency plans to assume in Year 2
Percent of the “Total Local Share Required” your agency plans to assume in Year 3
Percent Total
Local Share Year 1
Local Share Year 2
Local Share Year 3
Local Total
Federal Share Year 1
Federal Share Year 2
Federal Share Year 3
Federal Total
-

.

Standard Application Forms

ORI#

B. Base Salary and Fringe Benefits for Civilian/Non-Sworn Personnel
No Civilian/Non-Sworn Officer Positions Requested
Part 1: Instructions: Please complete the questions below for one non-sworn position salary and benefits package. As applicable per the program-specific Application Guide,
you may also be required to project Year 2 and Year 3 salaries.
A. Base Salary Information
Position Title
Description
(One position per worksheet)

Year 1 Salary
Enter the current first year base
salary for one civilian/non-sworn
position.
$

Year 2 Salary (As applicable) Enter
the second year base salary for one
civilian/non-sworn position.

Year 3 Salary (As applicable)
Enter the third year base salary for
one civilian/non-sworn position.

$

$

x

x

% of time on project =

% of time on project =

x

$

$

% of time on project =

$

B. Fringe benefit costs should be calculated for each year of the grant term.
FRINGE BENEFITS:

COST:
Social Security

Exempt:

Year 2 Fringe Benefits

Year 1 Fringe Benefits
6.2%

% OF BASE

COST:

Year 3 Fringe Benefits

% OF BASE

COST:

% OF BASE

Fixed Rate:

$

%

$

Fixed Rate:

$

%

$

%

$

%

Fixed Rate:

$

%

$

%

$

%

Fixed Rate:

$

%

$

%

$

%
%

%

$

%

Cannot exceed 6.2% of Total Base Salary.

Exempt:

Medicare

1.45%

Cannot exceed 1.45% of Total Base Salary.

Health Insurance Individual:

Family:

Life Insurance
Vacation

Number of Hours Annually:

$

%

$

%

$

Sick Leave

Number of Hours Annually:

$

%

$

%

$

%

%

$

%
%

Retirement

Fixed Rate:

$

%

$

Worker’s Compensation

Exempt:

Fixed Rate:

$

%

$

%

$

Unemployment Insurance

Exempt:

Fixed Rate:

$

%

$

%

$

%

Other Select One...

$

%

$

%

$

%

Other Select One...

$

%

$

%

$

Other Select One...

$

%

$

%

$

Benefits Sub-Total Per Year (1 Position)

$

$

$

Total (A+B)

$

$

$

D. Total Salary and Benefits for Years 1, 2, and 3 (1 Position): $
If requesting additional positions with identical budget check here

Indicate # of positions

Civilians/Non-Sworn Personnel Total $

If requesting other position(s) with different budget(s), check here

%
%

C. EQUIPMENT/TECHNOLOGY

No Equipment/Technology Requested

Instructions: List non-expendable items that are to be purchased. Provide a specific description for each
item and explain how the item supports the project goals and objectives as outlined in your application.
Non-expendable equipment is tangible property (e.g., information technology systems) having a useful life of
more than one year and an acquisition cost of $5,000 or more per unit. Expendable items should be included
either in the “SUPPLIES” or “OTHER” categories. Applicants should analyze the cost benefits of
purchasing versus leasing equipment, especially for high-price items and those subject to rapid technical
advances. Rented or leased equipment costs should be listed in the “CONTRACTS / CONSULTANTS”
category.
Please be advised that, to the greatest extent practical, all equipment and products purchased with these funds
must be American-made.
For agencies purchasing items related to enhanced communications systems, the COPS Office expects
and encourages that, wherever feasible, such voice or data communications equipment should be
incorporated into an intra- or interjurisdictional strategy for communications interoperability among
federal, state, and local law enforcement agencies.
See the program-specific Application Guide for a list of allowable/unallowable costs for this program.
Agencies are encouraged to limit their requests to the lines shown below and group similar items together so
that all items are accounted for on the budget worksheet for each category. However, if your agency requires
more lines please check the available box. Please limit your descriptions to 2000 characters.
Description
Item Name
Computation
Per Item Subtotal
(# of Items/Units X Unit Cost)

More Equipment/Technology Entries
Required

(

X

)

$

(

X

)

$

(

X

)

$

(

X

)

$

(

X

)

$

(

X

)

$

(

X

)

$

(

X

)

$

(

X

)

$

(

X

)

$

Equipment/Technology Total: $

No Supplies Requested

D. SUPPLIES

Instructions: List items by type (office supplies; postage; training materials; copying paper; books; handheld tape recorders; computing devices costing less than $5000; etc). Provide a specific description for
each item and explain how it supports the project goals and objectives outlined in your application.
Generally, supplies include any materials that are expendable or consumed during the course of the project
that are less than $5,000.
See the program-specific Application Guide for a list of allowable/unallowable costs for this program.
Agencies are encouraged to limit their requests to the lines shown below and group similar items together so
that all items are accounted for on the budget worksheet for each category. However, if your agency requires
more lines please check the available box. Please limit your descriptions to 2000 characters.
Computation

Item Name

Per Item Subtotal

(# of Items/Units X Unit Cost)

More Supply Entries Required

(

X

)

$

(

X

)

$

(

X

)

$

(

X

)

$

(

X

)

$

(

X

)

$

(

X

)

$

(

X

)

$

(

X

)

$

(

X

)

$

Supplies Total: $

Description

No Travel/Training Requested

E. TRAVEL/TRAINING

Instructions: Travel costs are the expenses for transportation, lodging, subsistence, and related items
incurred by employees who are in travel status on official business of the non-Federal entity. Itemize
grant-related travel expenses of grantee personnel (excluding consultants, whose expenses are listed in Section
F) by event (e.g., mandatory training, staff to training, field interviews, advisory group meetings). Identify the
location of travel whenever possible, and show the number of staff expected to attend each event. Training
fees, transportation, lodging and per diem rates for trainees should be listed as separate travel items. Grantee
travel costs specific to the grant project may be based on the grantee's written travel policy, assuming the costs
are reasonable. Grantees without a written travel policy must follow the established federal rates (found at
www.gsa.gov) for lodging, meals, and per diem. For all grantees (with or without a written travel policy),
airfare travel costs must be one of the following: the lowest discount commercial airfare, standard coach
airfare, or the Federal Government contract airfare (if authorized and available). Note: Any local training costs
(within a 50-mile radius) or any temporary dependent care costs should be listed under Section G ("Other Costs").
See the program-specific Application Guide for a list of allowable/unallowable costs for this program.
Agencies are encouraged to limit their requests to the lines shown below and group similar items together so
that all items are accounted for on the budget worksheet for each category. However, if your agency requires
more lines please check the available box. Please limit your descriptions to 2000characters.
Event Title and Location

Event Costs
Registration

$

Transportation

$

Lodging

$

Per diem

$

Registration

$

Transportation

$

Lodging

$

Per diem

$

Registration

$

Transportation

$

Lodging

$

Per diem

$

Registration

$

Transportation

$

Lodging

$

Per diem

$

Registration

$

Transportation

$

Lodging

$

Per diem

$
$

Transportation

$
$

Per diem

$

$

$

$

$

$

Registration

Lodging

Number of Staff Per Event Subtotal

$

Description

More Travel/Training Entries
Required

Travel/Training Total:

$

No Contracts/Consultants Costs Requested

F. CONTRACTS/CONSULTANTS

Instructions: See the program-specific Application Guide for a list of allowable/unallowable costs for the particular
program to which you are applying. Please limit your descriptions to 2000 characters.
1. Contracts: Provide a cost estimate for the product or service to be procured by contract. Applicants are
encouraged to promote free and open competition in awarding contracts. If awarded, requests for sole source
procurements of equipment, technology, or services in excess of $100,000 must be submitted to the COPS Office for
prior approval. (See Application Guide for more information on the required submission.)

Contract Name

Description

Per Contract Subtotal
$
$
$

Contract Subtotal:

$

2. Consultant Fees: For each consultant enter the name (if known), service to be provided, hourly or daily fee (based
upon an 8-hour day), and estimated length of time on the project. Unless otherwise approved by the COPS Office,
approved consultant rates will be based on the salary a consultant receives from his or her primary employer.
Consultant fees in excess of $550 per day require additional written justification and must be pre-approved in writing
by the COPS Office if the consultant is hired via a noncompetitive bidding process.
Consultant Name/Title

Service Provided

Per Consultant
Subtotal

Computation
( Cost X # Days)

(

X

) $

(

X

)

(

X

) $

Description

$

Consultant Fees Subtotal: $
3. Consultant Travel: List all travel-related expenses to be paid from the grant to the individual consultants (e.g.,
transportation, meals, lodging) separate from their consultant fees.
Consultant Name/
Event Title

Number Per Consultant
of Staff Travel Subtotal

Event Costs
Registration $
$

Transportation $
Lodging
$

$

Registration $
$
Per diem

Transportation $
Lodging
$

$

Per diem

Description

Consultant Travel Subtotal: $
4. Consultant Expenses: List all travel-related expenses to be paid from the grant to the individual consultants
separate from their consultant fees and travel expenses (e.g., computer equipment and office supplies).
Consultant Name/Title

Item(s)

Per Consultant
Expenses Subtotal

Description

$
$

Consultant Expenses Subtotal: $
Contracts/Consultants

(Contracts (F1) + Consultant Fees (F2) +
Consultant Travel (F3) + Consultant Expenses (F4))

$

No Other Costs Requested

G. OTHER COSTS

Instructions: List other requested items that will support the project goals and objectives as outlined in your
application. Provide a specific description for each item and explain how the item supports the project
goals and objectives as outlined in your application.
Please be advised that, to the greatest extent practical, all equipment and products purchased with these funds
must be American-made.
See the program-specific Application Guide for a list of allowable/unallowable costs for this program.
Agencies are encouraged to limit their requests to the lines shown below and group similar items together so
that all items are accounted for on the budget worksheet for each category. However, if your agency requires
more than lines please check the available box. Please limit your descriptions to 2000 characters.
Item Name

More Other
Costs
Entries
Required

Computation
(# of Items/Units X Unit Cost)

Per Item Subtotal

(

X

)

(

X

)

(

X

)

(

X

)

(

X

)

(

X

)

$

(

X

)

$

(

X

)

$

(

X

)

$

(

X

)

$

Description

$

$
$

$
$

Other Costs Total: $

67

No Indirect Costs Requested

H. INDIRECT COSTS

Instructions: Indirect costs are allowed under a very limited number of COPS programs. Please see the programspecific Application Guide for a list of allowable/unallowable costs for the particular program to which you are
applying.
If indirect costs are requested, a copy of the agency's fully-executed, negotiated Federal Rate Approval Agreement must
be attached to this application. Please limit your descriptions to 2000characters.
[If CHP and Tribal Agency, the text below will be displayed as second paragraph above.]

If your organization is requesting indirect costs for this project, please include a copy of your current, signed federallyapproved Indirect Cost Rate Negotiated Agreement. If the applicant does not have an approved rate, a rate can be
requested by contacting the applicant's cognizant federal agency, which will review all documentation and approve a
rate for the applicant organization. Please limit your description to 2000 characters.
Indirect Cost Description

Approved Indirect Cost Rate

Indirect Cost Total

$
More Indirect Costs
Entries Required

Indirect Costs Total: $

Description

BUDGET SUMMARY
Instructions: Please review the category totals and the total project costs below. If the category totals and
project amounts shown are correct, please continue with the submission of your application. Should you need
to make revisions to a budget category, please return to the Budget Detail Worksheet.
Budget Category

Category Total

A.

Sworn Officer Positions

$

B.

Civilian/Non-Sworn Personnel

$

C.

Equipment/Technology

$

D.

Supplies

$

E.

Travel/Training

$

F.

Contracts/Consultants

$

G.

Other Costs

$

H.

Indirect Costs

$
Total Project Amount:
Total Federal Share Amount:

(Total Project Amount X Federal Share Percentage Allowable)

Total Local Share Amount (If applicable):
(Total Project Amount - Total Federal Share Amount)

Edit

$
$

%

$

%

If your application is funded, but for a reduced number of officer positions, the percentage of the local share provided above
will be applied to the total project cost of the awarded officers.

Part 4. Waiver of Local Match
The COPS Office may waive some or all of a grantee's local match requirement based on severe fiscal distress. During the application review process,
your agency’s waiver request will be evaluated based on the availability of funding, a demonstration of severe fiscal distress as reflected through the
fiscal health data in Section 7 of this application, and a comparison of your fiscal health data with that of the overall CHP applicant pool.

Q1: Are you requesting a waiver of the local match based upon severe fiscal distress? YES/NO
If applicant answers “NO”, they would continue with the application; if “YES”, the following questions would appear:
Q1a: If awarded, please indicate the maximum local share your agency would be able to contribute to the total project cost in order to implement the
grant.
If your agency’s request for a waiver of the local match is approved and your application is fully funded, your federal share would be
.

and your local share would be

We anticipate that waivers of the local match will be limited. The COPS Office will carefully review your request for a waiver when your application is
submitted.
Q1b: If your agency does not qualify for a waiver, do you still wish to be considered for a CHP grant?
Yes, please continue to review my agency’s application even if we are not eligible for a waiver of the local match.
No, my agency could not implement this grant without a waiver of the local match, so please do not continue processing our application if we are
not eligible for the waiver.

ORI#

Standard Application Forms

BUDGET SUMMARY
Contact Information for Budget Questions
Please provide contact information of the financial official that the COPS Office may contact with questions
related to your budget submission.

Authorized Official’s Typed Name:
Title:
Phone:
Fax:
E-mail Address:

SECTION 15A: ASSURANCES
Several provisions of federal law and policy apply to all grant programs. The Office of Community Oriented Policing Services needs to secure your assurance
that the applicant will comply with these provisions. If you would like further information about any of these assurances, please contact your state’s COPS
Grant Program Specialist at 800-421-6770.
By signing this form, the applicant assures that it will comply with all legal and administrative requirements that govern the applicant for acceptance and use
of federal grant funds. In particular, the applicant assures us that:
1.

It has been legally and officially authorized by the appropriate governing body (for example, mayor or city council) to apply for this grant and that the
persons signing the application and these assurances on its behalf are authorized to do so and to act on its behalf with respect to any issues that may arise
during processing of this application.

2.

It will comply with the provisions of federal law, which limit certain political activities of grantee employees whose principal employment is in
connection with an activity financed in whole or in part with this grant. These restrictions are set forth in 5 U.S.C. § 1501, et seq.

3.

It will comply with the minimum wage and maximum hours provisions of the Federal Fair Labor Standards Act, if applicable.

4.

It will establish safeguards, if it has not done so already, to prohibit employees from using their positions for a purpose that is, or gives the appearance of
being, motivated by a desire for private gain for themselves or others, particularly those with whom they have family, business or other ties.

5.

It will give the Department of Justice or the Comptroller General access to and the right to examine records and documents related to the grant.

6.

It will comply with all requirements imposed by the Department of Justice as a condition or administrative requirement of the grant, including but not
limited to: the requirements of2

C.F.R. Part 200 (Uniform Administrative Requirements, Cost Principles, and Audit Requirements
for Federal Awards) as adopted by the Department of Justice in 2. C.F.R. § 2800.101; 48 C.F.R. Part 31 (FAR Part 31)
(Contract Cost Principles and Procedures); the applicable provisions of the Omnibus Crime Control and Safe Streets Act of 1968, as amended;
28 C.F.R. § 38.1; the applicable COPS Application Guide; the applicable COPS Grant Owner's Manual; and with all other applicable program
requirements, laws, orders, or regulations.
7.

It will, to the extent practicable and consistent with applicable law, seek, recruit and hire qualified members of racial and ethnic minority groups and
qualified women in order to further effective law enforcement by increasing their ranks within the sworn positions in the agency.

8.

It will not (and will require any subgrantees, contractors, successors, transferees, and assignees not to), on the ground of race, color, religion, national
origin, sex, disability, or age, unlawfully exclude any person from participation in, deny the benefits of or employment to any person, or subject any
person to discrimination in connection with any programs or activities funded in whole or in part with federal funds. These civil rights requirements are
found in the non-discrimination provisions of Title VI of the Civil Rights Act of 1964, as amended (42 U.S.C. § 2000d); the Omnibus Crime Control and
Safe Streets Act of 1968, as amended (42 U.S.C. § 3789d); Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 794); the Age
Discrimination Act of 1975 (42 U.S.C. §6101, et seq.); Title IX of the Education Amendments of 1972, as amended (20 U.S.C. § 1681 et seq.); and the
corresponding DOJ regulations implementing those statutes at 28 C.F.R. Part 42 (subparts C, D, E, G, and I). It will also comply with Executive Order
13279 Equal Treatment for Faith-Based Organizations and its implementing regulations at 28 C.F.R Part 38, which requires equal treatment of religious
organizations in the funding process and nondiscrimination of beneficiaries by Faith-Based Organizations on the basis of belief or non-belief.
A. In the event that any court or administrative agency makes a finding of discrimination on grounds of race, color, religion, national origin, gender,
disability or age against the applicant after a due process hearing, it agrees to forward a copy of the finding to the Office for Civil Rights, Office of
Justice Programs, 810 7th Street, NW, Washington, D.C. 20531.

9.

B. If your organization has received an award for $500,000 or more and has 50 or more employees, then it has to prepare an Equal Employment
Opportunity Plan (EEOP) and submit it to the Office for Civil Rights (“OCR”), Office of Justice Programs, 810 7th Street, N.W., Washington, DC
20531, for review within 60 days of the notification of the award. If your organization received an award between $25,000 and $500,000 and has 50 or
more employees, your organization still has to prepare an EEOP, but it does not have to submit the EEOP to OCR for review. Instead, your
organization has to maintain the EEOP on file and make it available for review on request. In addition, your organization has to complete Section B of
the Certification Form and return it to OCR. If your organization received an award for less than $25,000; or if your organization has less than 50
employees, regardless of the amount of the award; or if your organization is a medical institution, educational institution, nonprofit organization or
Indian tribe, then your organization is exempt from the EEOP requirement. However, your organization must complete Section A of the Certification
Form and return it to OCR.
Pursuant to Department of Justice guidelines (June 18, 2002 Federal Register (Volume 67, Number 117, pages 41455-41472)), under Title VI of the Civil
Rights Act of 1964, it will ensure meaningful access to its programs and activities by persons with limited English proficiency.

10. It will ensure that any facilities under its ownership, lease or supervision which shall be utilized in the accomplishment of the project are not listed on the
Environmental Protection Agency’ (EPA) list of Violating Facilities and that it will notify us if advised by the EPA that a facility to be used in this grant
is under consideration for such listing by the EPA.
11. If the applicant’s state has established a review and comment procedure under Executive Order 12372 and has selected this program for review, it has
made this application available for review by the state Single Point of Contact.
12. It will submit all surveys, interview protocols, and other information collections to the COPS Office for submission to the Office of Management and
Budget for clearance under the Paperwork Reduction Act of 1995 if required.

13. It will comply with the Human Subjects Research Risk Protections requirements of 28 CFR Part 46 if any part of the funded project contains non-exempt
research or statistical activities which involve human subjects and also with 28 CFR Part 22, requiring the safeguarding of individually identifiable
information collected from research participants.
14. Pursuant to Executive Order 13043, it will enforce on-the-job seat belt policies and programs for employees when operating agency-owned, rented or
personally-owned vehicles.
15. It will not use COPS funds to supplant (replace) state, local, or Bureau of Indian Affairs funds that otherwise would be made available for the purposes of
this grant, as applicable.
16. If the awarded grant contains a retention requirement, it will retain the increased officer staffing level and/or the increased officer redeployment level, as
applicable, with state or local funds for a minimum of 12 months following expiration of the grant period.
17. It will not use any federal funding directly or indirectly to influence in any manner a Member of Congress, a jurisdiction, or an official of any
government, to favor, adopt, or oppose, by vote or otherwise, any legislation, law ratification, policy or appropriation whether before or after the
introduction of any bill, measure, or resolution proposing such legislation, law, ratification, policy or appropriation as set forth in the Anti- Lobby Act, 18
U.S.C. § 1913.
18. In the event that a portion of grant reimbursements are seized to pay off delinquent federal debts through the Treasury Offset Program or other debt
collection process, it agrees to increase the non-federal share (or, if the awarded grant does not contain a cost sharing requirement, contribute a nonfederal share) equal to the amount seized in order to fully implement the grant project.
19.

None of the funds made available under this award may be distributed to the Association of Community
Organizations for Reform Now (ACORN) or its subsidiaries.

False statements or claims made in connection with COPS grants (including cooperative agreements) may result in fines, imprisonment, disbarment from
participating in federal grants or contracts, and/or any other remedy available by law.
I certify that the assurances provided are true and accurate to the best of my knowledge.
Elections or other selections of new officials will not relieve the grantee entity of its obligations under this grant.

Signature of Law Enforcement Executive/Agency Executive

Date

(For your electronic signature, please type in your name)

Signature of Government Executive/Financial Official

Date

(For your electronic signature, please type in your name)

Rev. 01/2012
e08097228

SECTION 15B: CERTIFICATIONS
Regarding Lobbying; Debarment, Suspension and Other Responsibility Matters; Federal Taxes and Assessments; Drug-Free Workplace
Requirements; and Coordination with Affected Agencies.
Although the Department of Justice has made every effort to simplify the application process, other provisions of federal law require us to seek your agency’s
certification regarding certain matters. Applicants should read the regulations cited below and the instructions for certification included in the regulations to
understand the requirements and whether they apply to a particular applicant. Signing this form complies with certification requirements under 28 CFR Part 69,
“New Restrictions on Lobbying,” 2 CFR Part 2867, “Nonprocurement Debarment and Suspension,” Public Law 111-117 or the most recent applicable
appropriations Act, 28 CFR Part 83, “Government-Wide Requirements for Drug-Free Workplace (Grants),” and the coordination requirements of the Public
Safety Partnership and Community Policing Act of 1994. The certifications shall be treated as a material representation of fact upon which reliance will be
placed when the Department of Justice determines to award the covered grant.
1. Lobbying

As required by 31 U.S.C. §1352, implemented at 28 C.F.R. Part 69, for persons entering into a grant or cooperative
agreement over $100,000, and 2 C.F.R. § 200.450 as adopted by the Department of Justice in 2 C.F.R. § 2800.101, the
applicant certifies that:
A. No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to
influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress
in connection with the making of any federal grant; the entering into of any cooperative agreement; and the extension, continuation, renewal,
amendment or modification of any federal grant or cooperative agreement;
B. If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or
employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with this
federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, “Disclosure of Lobbying Activities,” in
accordance with its instructions;

C. If applicant is a nonprofit organization or an institution of higher education, it will comply with the additional
lobbying restrictions set forth in 2 C.F.R. § 200.450(c) as adopted by the Department of Justice in 2 C.F.R. §
2800.101; and
D.. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including
subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all sub-recipients shall certify and disclose accordingly.
2. Debarment, Suspension and Other Responsibility Matters (Direct Recipient)
Pursuant to Executive Order 12549, Debarment and Suspension, as implemented at 2 CFR Part 2867, for prospective participants in primary covered
transactions, as defined at 2 CFR Part 2867.20(a), and other requirements, the applicant certifies that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of federal benefits by a state or federal court,
or voluntarily excluded from covered transactions by any federal department or agency;
B. Have not within a three-year period preceding this application been convicted of a felony criminal violation under any Federal law, or been convicted or
had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or
performing a public (federal, state or local) or private agreement or transaction; violation of federal or state antitrust statutes or commission of
embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion or receiving stolen property, making
false claims, or obstruction of justice, or commission of any offense indicating a lack of business integrity or business honesty that seriously and
directly affects your present responsibility;
C. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state or local) with commission of any of
the offenses enumerated in paragraph (B) of this certification; and
D. Have not within a three-year period preceding this application had one or more public transactions (federal, state or local) terminated for cause or
default.

3.

Mandatory Disclosure

Pursuant to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal
Awards, 2 CFR Part 200.113, as adopted by the Department of Justice in 2 C.F.R. § 2800.101, the applicant
certifies that it:
A. Has not violated any federal criminal law involving fraud, bribery, or gratuity that may potentially affect the
federal grant or cooperative agreement.
B. Shall timely disclose in writing to the federal awarding agency or pass-through entity, as applicable, any
violation of federal criminal law involving fraud, bribery, or gratuity that may potentially affect the federal
grant or cooperative agreement.
C. Shall require that the language of this certification be included in the award documents for all subawards
(including subgrants and cooperative agreements) and shall require all subrecipients certify and disclose
accordingly.

4. Federal Taxes and Assessments
A. If applicable, an applicant who receives an award in excess of $5,000,000 certifies that, to the best of its knowledge and belief, the applicant has filed all
Federal tax returns required during the three years preceding the certification, has not been convicted of a criminal offense under the Internal Revenue
Code of 1986, and has not, more than 90 days prior to certification, been notified of any unpaid Federal tax assessment for which the liability remains
unsatisfied, unless the assessment is the subject of an installment agreement or offer in compromise that has been approved by the Internal Revenue
Service and is not in default, or the assessment is the subject of a non-frivolous administrative or judicial proceeding.
B. The applicant certifies that it does not have any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies
have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting
the tax liability.
5. Drug-Free Workplace (Grantees Other Than Individuals)
As required by the Drug-Free Workplace Act of 1988, and implemented at 28 CFR Part 83, for grantees/recipients, as defined at 28 CFR §83.660 - A.
The applicant certifies that it will, or will continue to, provide a drug-free workplace by:
(i) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled
substance is prohibited in the grantee’s workplace and specifying the actions that will be taken against employees for violation of such
prohibition;
(ii) Establishing an on-going drug-free awareness program to inform employees about (a) The dangers of drug abuse in the workplace;
(b) The grantee’s policy of maintaining a drug-free workplace;
(c) Any available drug counseling, rehabilitation and employee assistance programs; and
(d) The penalties that may be imposed upon employees for drug-abuse violations occurring in the workplace;
ORI#

v) Notifying the employee in the statement required by paragraph (i) that, as a condition of employment
Standard
Application Forms
under

(iii)
Making it
a
requirem
ent that
each
employee
to be
engaged
in the
performa
nce of the
grant be
given a
copy of
the
statement
required
by
paragraph
(i);
(

the grant, the employee will - (a) Abide by the terms of the statement; and
(b) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the
workplace no later than five
calendar days after such conviction;
(v) Notifying the agency, in writing, within 10 calendar days after receiving notice under subparagraph (iv)(b) from an
employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice,
including position title, to: COPS Office, 145 N
St, NE, Washington, D.C. 20530. Notice shall include the identification number(s) of each affected grant;
(vi) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (iv)(b), with respect to
any employee who is so convicted (a) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the
requirements of the
Rehabilitation Act of 1973, as amended; or
(b) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved
for such purposes by a federal, state or local health, law enforcement or other appropriate agency;
(vii) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (i), (ii), (iii),
(iv), (v), and (vi).
B. The applicant further certifies that it will identify all known workplaces under each
COPS Office award, keep the identification documents on file, and make them
available for inspection upon request by the Department of Justice officials or their
designated representatives.

i
6. The Public Safety Partnership and Community Policing Act of 1994 requires applicants to certify that there has been appropriate coordination with all
agencies that may be affected by the applicant’s grant proposal if approved. Affected agencies may include, among others, the Office of the United States
Attorney, state or local prosecutors, or correctional agencies. The applicant certifies that there has been appropriate coordination with all affected
agencies.
Where the applicant is unable to certify to any of the statements in this Certifications form, he or she shall attach an explanation to this application
regarding the particular statement that cannot be certified. Please check here
if an explanation is attached to this application. Please note that the
applicant is still required to sign the Certifications form to certify to all the other applicable statements.
False statements or claims made in connection with COPS grants (including cooperative agreements) may result in fines, imprisonment, disbarment from
participating in federal grants or contracts, and/or any other remedy available by law.
I certify that the assurances provided are true and accurate to the best of my knowledge.

Elections or other selections of new officials will not relieve the grantee entity of its obligations under this grant.

Signature of Law Enforcement Executive/Agency Executive
(For your electronic signature, please type in your name)

Date

Signature of Government Executive/Financial Official
(For your electronic signature, please type in your name)

Date
Rev. 01/2012
e08097228

SECTION 16: DISCLOSURE OF LOBBYING ACTIVITIES
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal
action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to
make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial
filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.
1.

Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2.

Identify the status of the covered Federal action.

3.

Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported,
enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered
Federal action.

4.

Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate
classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the
first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

5.

If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, State and zip code of the prime Federal
recipient. Include Congressional District, if known.

6.

Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known.
For example, Department of Transportation, United States Coast Guard.

7.

Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance
(CFDA) number for grants, cooperative agreements, loans, and loan commitments.

8.

Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number;
Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number
assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."

9.

For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan
commitment for the prime entity identified in item 4 or 5.

10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting
entity identified in item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and
Middle Initial (MI).
11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control Number.
The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10
minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503.

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See reverse for public burden disclosure.)

1. Type of Federal Action:
2. Status of Federal Action:
3. Report Type:
a. contract
a. bid/offer/application
a. initial filing
b. grant
b. initial award
b. material change
For Material Change Only:
c. cooperative agreement
c. post-award
d. loan
year
quarter
e. loan guarantee
date of last report
f. loan insurance
5. If Reporting Entity in No. 4 is a Subawardee, Enter Name
4. Name and Address of Reporting Entity:
Subawardee
and Address of Prime:
Prime
Tier
, if known :

Congressional District, if known : 4c
6. Federal Department/Agency:

Congressional District, if known :
7. Federal Program Name/Description:

CFDA Number, if applicable :
8. Federal Action Number, if known :

9. Award Amount, if known :
$

10. a. Name and Address of Lobbying Registrant
( if individual, last name, first name, MI ):

b. Individuals Performing Services (including address if
different from No. 10a )
(last name, first name, MI ):

requested through this
11. Information
1352. This disclosure of lobbying

Signature:

form is authorized by title 31 U.S.C. section
activities is a material representation of fact
upon which reliance was placed by the tier above when this transaction was made
or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This
information will be available for public inspection. Any person who fails to file the
required disclosure shall be subject to a civil penalty of not less than $10,000 and
not more than $100,000 for each such failure.

Print
Title:
Telephone No.:

Federal Use Only:

Approved by OMB
0348-0046

Name:

Date:
Authorized for Local Reproduction
Standard Form LLL (Rev. 7-97)

SECTION 17: REVIEWS AND CERTIFICATIONS
1) Federal Civil Rights and Grant Reviews:
Please be advised that an application may not be funded and, if awarded, a hold may be placed on the award if it is
deemed that the applicant is not in compliance with federal civil rights laws, and/or is not cooperating with an ongoing
federal civil rights investigation, and/or is not cooperating with a Department of Justice grant review or audit.
2) Certification of Review of 28 C.F.R. Part 23/Criminal Intelligence Systems:
Please review the COPS Application Guide: Legal Requirements Section for additional information.
Please check one of the following, as applicable to your agency’s intended use of this grant:
No, my agency will not use these COPS grant funds (if awarded) to operate an interjurisdictional criminal
intelligence system.
Yes, my agency will use these COPS grant funds (if awarded) to operate an interjurisdictional criminal
intelligence system. By signing below, we assure that our agency will comply with the requirements of 28 C.F.R.
Part 23.
3) Certification of Review and Representation of Compliance with Requirements:
The signatures of the Law Enforcement Executive/Agency Executive, Government Executive/Financial Official, and
the Person Submitting this Application on the Reviews and Certifications represent to the COPS Office that:
a) the signatories have been legally and officially authorized by the appropriate governing body to submit this
application and act on behalf of the grant applicant entity;
b) the applicant will comply with all legal, administrative, and programmatic requirements that govern the applicant
for acceptance and use of federal funds as outlined in the applicable COPS Application Guide, the COPS Grant
Owner’s Manual, Assurances, Certifications, and all other applicable program regulations, laws, orders, and
circulars;
c) the applicant understands that false statements or claims made in connection with COPS programs may result in
fines, imprisonment, debarment from participating in federal grants, cooperative agreements, or contracts, and/or
any other remedy available by law to the federal government; AND
d) the information provided in this application, including any amendments, shall be treated as material
representations of fact upon which reliance will be placed when the Department of Justice determines to award the
covered grant.
e) the applicant understands that as a general rule COPS funding may not be used for the same item or service funded
through another funding source.

f) the applicant and any required or identified official partner(s) listed in Section 12 are partners in this grant project
and mutually agreed to this partnership prior to this grant application.

The signatures of the Law Enforcement Executive/Agency Executive and the Government Executive/Financial Official
on this application must be the same as those identified in Section 4 of this application. Applications with missing,
incomplete, or inaccurate signatories or responses may not be considered for funding.

Signature of Law Enforcement Executive/Agency Executive

Date

(For your electronic signature, please type in your name)

Signature of Government Executive/Financial Official

Date

(For your electronic signature, please type in your name)

Signature of the Person Submitting This Application

Date

(For your electronic signature, please type in your name)

By clicking this box, the applicant understands that the use of typed names in this grant application and the required
grant forms, including the Assurances and Certifications, constitute electronic signatures and that the electronic
signatures are the legal equivalent of handwritten signatures.

SECTION 18: APPLICATION DATA VERIFICATION
By signing below, I certify that I have read, understand and agree to the following:
a)

my agency has been requested by the COPS Office to review, confirm and/or update specific data items that
were previously submitted in our COPS application and our failure to respond to the request may eliminate
our application from 2015 funding consideration;

b) my agency has reviewed, confirmed and/or updated the specific data items identified by the COPS Office,
and certify that the information is true and accurate;
c)

I am authorized by the appropriate governing body to act on behalf of the grant applicant entity to make
changes to our COPS application which will be considered for 2015 funding;

d) the information provided in this application, including any amendments, shall be treated as material
representations of fact upon which reliance will be placed when the Department of Justice determines to
award the covered grant; and
e)

the applicant understands that false statements or claims made in connection with COPS programs may
result in fines, imprisonment, debarment from participating in federal grants, cooperative agreements, or
contracts, and/or any other remedy available by law to the federal government.

Signature of the Person Completing this Form

Date Completed

(For your electronic signature, please type in your name)

ELECTRONIC SIGNATURE: By clicking this box , I understand that typing in my name on this form constitutes
an electronic signature and that the electronic signature is the legal equivalent of a handwritten signature.
In order for your agency to be considered for COPS grant funding, all application updates must be submitted through
the COPS website (www.cops.usdoj.gov) by <>. For technical assistance with submitting your updates or
to withdraw your agency's application from funding consideration, please call the COPS Office Response Center at
800-421-6770.

Paperwork Reduction Act Notice
The public reporting burden for this collection of information is estimated to be up to 11.3 hours per response,
depending upon the COPS program being applied for, which includes time for reviewing instructions. Send comments
regarding this burden estimate or any other aspects of the collection of this information, including suggestions for
reducing this burden, to the Office of Community Oriented Policing Services, U.S. Department of Justice, 145 N Street,
NE, Washington, DC 20530; and to the Public Use Reports Project, Office of Information and Regulatory Affairs,
Office of Management and Budget, Washington, DC 20503.
You are not required to respond to this collection of information unless it displays a valid OMB control number. The
OMB control number for this application is 1103-0098 and the expiration date is 02/29/2016.

FOR MORE INFORMATION:
U.S. Department of Justice
Office of Community Oriented Policing Services
145 N Street, NE
Washington, DC 20530
To obtain details on COPS programs, call the
COPS Office Response Center at 800-421-6770
Visit COPS Online at www.cops.usdoj.gov.

e011011250

Revised Date:
February 2015