Grant Request Form

Digital Imaging Program Fund Grant Request Form

Agency Information

Agency Name:

Mailing Address:

Division/Office:

Phone:

Agency Contact Person

Project Description

1. Describe the digital imaging project.

Describe the purpose and description of the project, benefit to the agency, scope of the project, size of the project, timeline for the project completion

2. Is this project eligible for Federal funding (matching or otherwise?) If so, please describe.

3. Provide a cost estimate of the project

Please include a detailed cost breakdown of the vendor's service costs. Also, provide information identifying when fund disbursements are required to meet the vendor payment obligations. A written estimate from the State Use Vendor is required and should be submitted to Philip.Michael@ks.gov. Applications will not be accepted without a written estimate from the State Use Vendor. The following link provides contact information for the State Use Vendor. http://www.ksstateuse.org/content.asp?MerchantID=KSSTATE1&ContentID=AgencyBTCO

4. Will the agency contract with the vendor to ensure the information will be delivered, handled, and stored in a secure manner in accordance with applicable Federal and State requirements?

Yes
No

If yes, please describe the security measures used by the vendor to ensure information security.

If no, please describe the security measures the agency will utilize to ensure information security.

5. Does the agency have alternative means of funding for digital imaging projects? If so, please describe.

6. Please include any other information the agency feels is important in the funding decision.

7. How does the agency plan to utilize the digitized documents?

Please describe the methods of access (within agency and to public if applicable), agency use, and digital storage.

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