Grant Forms
Please note that not all forms are required for every funding source. Refer to your RFA for instructions on which forms are required and how to name and number them as attachments to your application.
- 2024 Byrne State Crisis Intervention Program
- 2023 Byrne Justice Assistance Grants (JAG) Request for Application
- 2023 Children’s Justice Act (CJA) Request for Application
- 2023 Juvenile Justice/Title II (JJ) Request for Application
- 2023 Victims of Crime Act (VOCA) Request for Application (Revised as of Dec. 8, 2022)
- 2023 Violence Against Women Act (VAWA-STOP) Request for Application
De Minimis Certification Form
Detailed Budget Narrative Form
NC Human Trafficking Commission Acknowledgement Letter/Form (HT Projects Only)
Participant Support Costs
Staffing Allocation Form
Sample Memorandum of Understanding
Sample Contract Template
Sample Detailed Supply List
Culturally Specific Organization Verification Letter
Legal Services Certification Letter
Assurance Concerning Polygraph Testing Prohibition
Summary of Direct and Contracted GCC Funds Form
Sample Template for Data Breach or Imminent Breach Procedures
Budget Clarification Worksheet
CVS FAQ
Single Audit Form
Certification of No Overdue Tax Debt
Certifications Regarding Lobbying; Debarment; Suspension and Other Responsibility Matters; and Drug-Free Workplace Requirements
Employment Eligibility Verification Form
Advanced Determination of Suitability Form
NCID Acceptable Use Policy
Confidentiality Assurance Form
Policy for Reporting Workplace Incidents
Civil Rights Compliance Forms
Expense Reimbursement Cover Pages
Time and Activity Forms
- Multiple Funding Sources (4)
- Multiple Funding Sources (6)
- Multiple Funding Sources (14)
- Match or Single Funding Source
State Grant Compliance Reporting Forms
Level 1: Between $1 and $999,999 in state and federal pass-through funds
- Certification Form
- Schedule of Receipts and Expenditures
- Program Activities and Accomplishments
- Send reports to: DPS_GrantComplianceReports@ncdps.gov
Level 2: $1,000,000 or more in state and federal pass-through funds
- Certification Form
- Schedule of Receipts and Expenditures
- Program Activities and Accomplishments
- Submission of required single (or program-specific) audit in accordance with Generally Accepted Government Auditing Standards (gao.gov/yellowbook)
- Send reports to DPS_GrantComplianceReports@ncdps.gov
Addition if $1,000,000 or more in federal expenditures (see also 2 CFR 200.501)
- Submit federally required audit to: harvester.census.gov/facweb/
- Make copies of audit available to public.
Visit the State Controller website to select and complete the necessary forms for processing.
- State of North Carolina Substitute W-9 Form: Select and download the Substitute W-9. Email the completed form to GCC_Grants_Management@ncdps.gov and cc your grants administrator.
- Supplier Electronic Payment Form: Select and download both Supplier Electronic Payment Information and Supplier Electronic Payment Form. Follow the instructions on the form for submittal.