Applicant Contact Information – Authorized Organization Representative/Signing Official |
Field Name | Instructions |
Prefix | Enter the prefix (e.g. Mr., Ms., Rev., Dr.) for Authorized Representative. |
First Name | Enter the first (given) name of the Authorized Representative. This field is required. |
Middle Name | Enter the middle name of the Authorized Representative. |
Last Name | Enter the last name of the Authorized Representative. This field is required. |
Suffix | Enter the suffix (e.g., Jr., Sr., Ph.D.) of the Authorized Representative. |
Position/Title | Enter the position or title of the Authorized Representative. This field is required. |
Organization | Enter the name of the organization for the Authorized Representative. This field is required. |
Department | Enter the name of the primary organizational department, service, laboratory, or equivalent level within the organization of the Authorized Representative. |
Division | Enter the name of the primary organizational division, office, or major subdivision of the Authorized Representative. |
Street 1 | Enter the first line of the street address for the Authorized Representative. This field is required. |
Street 2 | Enter the second line of the street address for the Authorized Representative if additional line is needed, for example suite number or building number. This field is optional. |
City | Enter the city for address of the Authorized Representative. This field is required. |
County/Parish | Enter the county or parish for the address of the Authorized Representative. |
State | Enter the state where the Authorized Representative is located. This field is required if the applicant is located in the United States. |
Province | Enter the province for the Authorized Representative. |
Country | Select the country for the address of the Authorized Representative. For SBIR/STTR applications, the small business concern must be located in the United States. |
Zip Code | Enter the nine-digit postal code of the Authorized Representative. This field is required if the applicant is located in the United States. If a province is selected, this field is optional. |
Phone Number | Enter the daytime phone number of the Authorized Representative. This field is required. |
Fax Number | Enter the fax number of the Authorized Representative. |
Email | Enter the email address for the Authorized Representative. Provide only one email address. This field is required. |
Signature of Authorized Representative | It is the organization’s responsibility to ensure that only properly authorized individuals sign in this capacity and/or submits the application to Grants.gov. If this application is submitted through Grants.gov, leave blank. If a hard copy is submitted, the AOR must sign this block. |
Date Signed | If this application is submitted through Grants.gov, the system will generate this date. If submitting a hard copy, enter the date the AOR signed the application. |