A r c h i v e d  I n f o r m a t i o n

APPENDIX C

Recommended Application Forms

Schools and Libraries Universal Service Fund

Application for Eligible Services

FCC Form III

BLOCK 1: Requester/Notifier Information

1.	Name of Requester/Notifier
	___________________________________________________
2.	Requester Control Number
	___________________________________________________
3.	Funding Request Control Number
	___________________________________________________

4.	Contact Person's Name
	___________________________________________________

5.	Mailing Address

	___________________________________________________
	___________________________________________________

	City	State	Zip Code

	___________________________________________________

	___________________________________________________

	Telephone Number	Fax Number	E-mail Address

[ Form II, Block 3: Certifications, Signatures and Seal of Notary Public ]				[ Form III, Block 2: Commencement of Service

This page last updated 8/10/97 (pjh).