Indicates required field Please complete all required fields marked with an asterisk (*). This form is for FY27 appropriations requests. Your Contact Information Prefix: - Select -Ms.Miss.Mrs.Mr.Mr. and Mrs.Rev.Dr.The HonorableRabbi First Name: MI: Last Name: Suffix: - None -2nd3rd4thIIIIIIVJr.Sr.M.D.PH.D.and Family Address Address Address 2 City/Town State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code Email: Contact Phone Number: Phone Number Alternate Phone Number Phone Type: - None -Standard voice telephoneVideophone [VP]Text-telephone device [TTD] phone text What are these options? Constituents who are hard of hearing or use a video phone have the option to choose TDD or VP based on the type of device they are using. This allows our office to respond to them accordingly. The default option 'Voice' is a standard audible telephone. Organization Information Organization Making the Request: Organization Head First Name: Organization Head Last Name: Organization Address Organization Street Address Street Address Continued City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Organization or Project Website: Address of the Requested Project/Program Project Address Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Appropriation Request Name of Project: Appropriations Bill: - Select -AgricultureCommerce, Justice, ScienceDefenseEnergy and WaterFinancial ServicesHomeland SecurityInteriorLabor, Health and Human ServicesLegislative BranchMilitary Construction, Veterans AffairsState and Foreign OperationsTransportation, and Housing and Urban Development Agency: Account: Dollar Amount Requested: $ Estimated Project Start Date: Estimated Project End Date: Total Project Cost: $ General Information Describe the problem or issue to be addressed through this request. Please include as many details as possible and explain why the problem cannot be addressed without the appropriation. Describe the project or program, what it will do and why it is necessary. Describe the services and projects that will be provided and the reasons for your request. How does this request benefit the district? Please include all such partners with whom you will be working or from whom you have requested additional funding for your program or project. Provide a brief explanation justifying the request and how it is a good use of taxpayer funds. Funding Information Can the project obligate all appropriated funds within 12 months of enactment? Yes No If no, please explain: Is the project scalable if the requested amount is not fully met? Yes No Has the project previously received federal funds? Yes No If so, please describe. Please include both formula funds and any discretionary grants and the applicable fiscal years for these funds. Can the project obtain other public and/or private funds to meet cost-share requirements? Some (but not all) CPF accounts require a local or institutional match for funding. Yes No FY27 President’s Budget Request Amount FY26 Enacted Amount Additional Information Letters of Support from Community Partners: You may upload up to 5 documents. Accepted formats: PDF, DOC, DOCXMaximum 5 files.2 MB limit.Allowed types: pdf doc docx. Are you submitting this request to another House Member or Senator? Yes No Please list the additional Members and/or Senators If you are submitting multiple projects for consideration, please rank each of them in order of priority. Please list the project names in order of priority (highest to lowest). Request submitted to another subcommittee this fiscal year?" Yes No If yes, which subcommittees? CAPTCHA: enabled to secure this form. If you are having difficulty using Captcha's visual option, please visit the Accessibility page for more assistance.