Direct questions to:
Ann Hepenstal
Community Emergency
Preparedness Coordinator
ahepenstal@losaltosca.gov
www.losaltosca.gov/cepg
To be eligible for reimbursement under this grant program:
By 5:00pm, May 22, 2020, your BAT or Neighborhood Watch group must have at least 1
resident who has completed Community Emergency Response Training (CERT) and
registered with the City of Los Altos as a Disaster Service Worker volunteer, OR has registered
for a 2020 CERT training academy.
Name of your CERT Disaster Service Worker volunteer or name of person who has
registered and intended location of training:
______________________________________________________________________
I understand that my BAT or Neighborhood Watch Group must meet this requirement
in order to be eligible for reimbursement under this grant program:
Signature:
____________________________
To be eligible for reimbursement under this grant program, your BAT or
Neighborhood Watch group must have at least 40% of its residents registered for the
AlertSCC emergency notification system by 5:00pm May 22, 2020. I understand that my BAT or
Neighborhood Watch Group must meet this requirement in order to be eligible for reimbursement
under this grant program:
Signature:
____________________________
By applying for this community & Emergency Preparedness Grant, and signing below, Applicant agrees to use the grant funds for
the specific purpose stated in your grant application and that you agree to allow the City of Los Altos to publicize any grant
award and information about your project (including photos). Further, Applicant also acknowledges and agrees to hold
harmless the City of Los Altos, its elected officials, officers, employees, agents, and volunteers against all claims, demands, suits,
damages, losses, liabilities, costs, fees, damage, or injury of any kind, in law or equity, to property or persons, arising or resulting
from any use of the grant funds or any event or project supported by the grant funds.
Applicant Name:
Home Address:
Email Address:
Phone Number:
Applicant Signature:
_________________________________________________
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________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
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