OMB Number: 4040-0004Expiration Date: 01/31/2009Application for Federal Assistance SF-424 Version 02* 1. Type of Submission:m Preapplicationl Applicationm Changed/Corrected Application* 2. Type of Application: * If Revision, select appropriate letter(s):l Newm Continuation * Other (Specify)m Revision* 3. Date Received: 4. Applicant Identifier:12/08/20085a. Federal Entity Identifier: * 5b. Federal Award Identifier:State Use Only:6. Date Received by State: 7. State Application Identifier:8. APPLICANT INFORMATION:* a. Legal Name: University of Southern Indiana* b. Employer/Taxpayer Identification Number (EIN/TIN): * c. Organizational DUNS:35-1308176 180524274d. Address:* Street1: Street2:* City: County:* State: Province:* Country:* Zip / Postal Code:EvansvilleVanderburghIN: IndianaUSA: UNITED STATES477128600 University Blvde. Organizational Unit:Department Name: Division Name:Extended Servicesf. Name and contact information of person to be contacted on matters involving this application:Prefix:Middle Name:* Last Name:Suffix:* First Name:CleekMs. LindaTitle: Associate Dean of Extended ServicesOrganizational Affiliation:University of Southern Indiana* Telephone Number: Fax Number: 812/464-1863 812/465-7061* Email: LCleek@usi.eduTracking Number: GRANT00555082 Funding Opportunity Number: CDC-PA-HM09-901 Received Date: 2008-12-08 11:30:13.000-05:00 Time Zone: GMT-5
