The undersigned affirms under penalties of perjury that the responses to this Grant Application are true and correct to the best of his/her knowledge. On behalf of the Applicant, the undersigned acknowledges that this Grant Application may not be approved or that the Commission’s grant budget may be insufficient to fund this Application even if approved. The Applicant’s sole recourse to such non-approval or failure to fund is to submit another application to the Commission.

If awarded a grant by ANC 5A, I certify that within 60 days after the grant award is disbursed that I shall forward to the Commission a statement as to the use of the funds received. This statement should be consistent with the information in the original grant form. The appropriate documentation, including invoices, sales receipts, etc., must also be submitted to the Commission along with the report. Failure to meet these requirements shall hold the organization that I represent liable for the repayment of grant funds received to ANC 5A.