NC Firewise - Grant Forms

New state legislation has been passed, 01 July 2005, requiring additional documentation and reporting for applicants who are NOT subject to State government or Local Government Commission rules: G.S.143-6.2 “Use of State Funds by Non-State Entities”. State funds are defined as state allocations as well as federal funds administered by the State.

This means that private educational facilities and all non-profits, including RC&Ds, must supply the new, state-mandated forms. Municipalities, state-funded educational facilities, K-12 schools, county governments and Cooperative Extension are NOT required to meet the additional application and reporting requirements. If you are unsure whether your organization must meet the new requirements, please contact us and we will assist you in making that determination as well as assist you in meeting the requirements.

Additional Application Forms
For non-state entities, these additional forms are required for your application. All forms and instructions are attached in a single file.

Certification of No Overdue Tax Debts
Federal Certification Regarding Lobbying
Federal Certification Regarding Debarment
Federal Certification Regarding Drug-Free Workplace
501(c) Non-Profits Conflict of Interest Statement Certified/Approved by Board, as appropriate

All Forms in One File (MS Word)

If you are a non-profit you must also supply your copy of:

IRS Federal Tax Exempt Letter or 501(c) Verification Form

Additional Reporting Requirements For non-state entities, additional reporting is also required by the statute during the contract period. The form you use is based on total funds received from the state, not from the U&CF Program alone.
	State Grants Compliance Reporting for total State funds received <$25,000 Receipt of <$25,000 of Funds Form (MS Word) State Grant Certification form (MS Word) Forms must be submitted following each fiscal year the grant contract is active. Final forms may be submitted at contract completion if the grantee has no other state funding sources.

	State Grants Compliance Reporting for total State funds received >$25,000 and <$500,000 Receipt of >$25,000 and <$500,000 Form (MS Word) State Grant Certification form (MS Word) Schedule of Receipts and Expenditures Form (MS Excel) Program Activities and Accomplishment Form (MS Word)

	State Grants Compliance Reporting for total State funds received >$500,000 Receipt of >$500,000 Form (MS Word) Submitted to the U&CF Grant Program within 6 months of a grantee’s fiscal year end, which is then forwarded to the Office of the State Auditor, submitted yearly if the grant crosses two fiscal years State Grant Certification form (MS Word) Schedule of Receipts and Expenditures Form (MS Excel) Program Activities and Accomplishment Form (MS Word) Audit to Firewise Program and Office of the State Auditor