Form SFN59510 "Centers of Excellence Disbursement Request" - North Dakota

What Is Form SFN59510?

This is a legal form that was released by the North Dakota Department of Commerce - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2016;
  • The latest edition provided by the North Dakota Department of Commerce;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SFN59510 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Commerce.

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Download Form SFN59510 "Centers of Excellence Disbursement Request" - North Dakota

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CENTERS OF EXCELLENCE DISBURSEMENT REQUEST
NORTH DAKOTA DEPARTMENT OF COMMERCE
SFN 59510 (01-16)
Instructions: The Disbursement Request Form must be completed to initiate any and all disbursements of award
funds. Upon its satisfactory review of the request, the Commission will direct the North Dakota Department of
Commerce to issue the appropriate disbursement of Centers of Excellence award funds.
All Disbursement Requests: When making disbursement requests, a center must demonstrate private sector
participation and availability of statutorily required matching funds. All necessary supporting documentation must be
attached to this form.
First Disbursement: All additional funding conditions were placed upon a center at the time of approval must
be met prior to requesting a distribution. Attach supporting documentation.
Subsequent Disbursements: In addition to private sector participation and availability of statutorily required
matching funds, the Centers of Excellence Commission will consider the amount of statutorily required
matching funds already received by a center making a disbursement request. Attach documentation of any
matching funds received since the center’s latest functional review.
NOTE: If this disbursement request represents a deviation from the center’s budget and/or timeline, a revised budget
and budget narrative must also be provided.
Submission: Disbursement Request Forms are to be submitted electronically to the North Dakota Department of
Commerce at researchND@nd.gov.
Program:
COE
CORE
LD-CAP
Research ND
Research ND BIO
Fast Track
Venture Grant Phase I
Venture Grant Phase II
Enhancement
Base Realignment
Center/Project Name
Amount of Disbursement Request
Award Funds Received to Date
Award Funds Spent to Date
Total Matching Funds Received to Date
Total Matching Funds Anticipated
This Disbursement Request Form is a formal request of the Centers of Excellence Commission to direct the North
Dakota Department of Commerce to issue the disbursement described above to the center identified above. I certify
that the information contained herein this request is accurate to my knowledge. I further certify that I am an authorized
signor for the institution making the disbursement request.
Authorized Signature/Title
Printed Name
Date
PI/Center Director Signature
Printed Name
Date
Send payment to:
Name
Mailing Address
City
State
ZIP Code
CENTERS OF EXCELLENCE DISBURSEMENT REQUEST
NORTH DAKOTA DEPARTMENT OF COMMERCE
SFN 59510 (01-16)
Instructions: The Disbursement Request Form must be completed to initiate any and all disbursements of award
funds. Upon its satisfactory review of the request, the Commission will direct the North Dakota Department of
Commerce to issue the appropriate disbursement of Centers of Excellence award funds.
All Disbursement Requests: When making disbursement requests, a center must demonstrate private sector
participation and availability of statutorily required matching funds. All necessary supporting documentation must be
attached to this form.
First Disbursement: All additional funding conditions were placed upon a center at the time of approval must
be met prior to requesting a distribution. Attach supporting documentation.
Subsequent Disbursements: In addition to private sector participation and availability of statutorily required
matching funds, the Centers of Excellence Commission will consider the amount of statutorily required
matching funds already received by a center making a disbursement request. Attach documentation of any
matching funds received since the center’s latest functional review.
NOTE: If this disbursement request represents a deviation from the center’s budget and/or timeline, a revised budget
and budget narrative must also be provided.
Submission: Disbursement Request Forms are to be submitted electronically to the North Dakota Department of
Commerce at researchND@nd.gov.
Program:
COE
CORE
LD-CAP
Research ND
Research ND BIO
Fast Track
Venture Grant Phase I
Venture Grant Phase II
Enhancement
Base Realignment
Center/Project Name
Amount of Disbursement Request
Award Funds Received to Date
Award Funds Spent to Date
Total Matching Funds Received to Date
Total Matching Funds Anticipated
This Disbursement Request Form is a formal request of the Centers of Excellence Commission to direct the North
Dakota Department of Commerce to issue the disbursement described above to the center identified above. I certify
that the information contained herein this request is accurate to my knowledge. I further certify that I am an authorized
signor for the institution making the disbursement request.
Authorized Signature/Title
Printed Name
Date
PI/Center Director Signature
Printed Name
Date
Send payment to:
Name
Mailing Address
City
State
ZIP Code