ApplicantTown:

Applicant Address:

Project Location: EligibleMunicipality: Yes No

Proposed STEAP Funding $Total Project Cost $

Eligibility Analysis:

Please provide a brief description of the project that includes the purpose of the project, the sources and the use of funds. (Example= Economic Development: Extend utilities to industrial park; Water/Sewer: 500 Ft water extension along Hop Spring Road; Road Improvement: Pave Smith Road; Park and Recreation: New Playscape at Hill Park)

Project Requirements

  1. Provide a narrative of how your project will impact and benefit the community. (If necessary attach in separate letter)
  1. Describe the Fund Raising process for the project?

a. What are the capital funding needs?

b. How much has been raised to date?

c. What is anticipated source and timeline for the remaining funds?

d. Provide any other details on the project's fundraising.

  1. Provide a project management and administrative plan. Describe the operational capacity, experience, financial viability of the organization that will develop and manage the project. Please include an organization chart:

Assess the economic benefits the project will provide to the community (if possible)

Estimated InYear 1Year 2Year 3Year 4

Corporate Taxes$$$$______

Payroll Taxes$$$$______

Sales Tax$$$$______

Local Taxes$$$$______

Full Time Job Retained______

Full Time Job Created______

Project Sources and Uses of Funds
Sources / Non-STEAP Funds / STEAP Funds / Total
STEAP Grant
Local Funds
Federal Funds
Other
Total
Uses
Professional Services
Acquisition
Construction/Renovation
Other
Contingency
Total

Identify Town Officials and Professionals involved in developing, working on and managing the project.

Print Name, Title and Phone Number

Print Name, Title and Phone Number

Print Name, Title and Phone Number

Attach the following material

  1. Site Location Map (if applicable)
  2. Real Estate appraisals (if land acquisition is proposed)
  3. Proposed project schedule
  4. Project cost estimates supporting the request for funding (if available)
  5. List of necessary local/state/federal permits and approvals required for the project
  6. State plan of conservation and development: If project proposal is contrary to the State Plan of Conservation and Development, attach a narrative explaining why the project should move forward and how the project will further overall C&D goals across the State. Include information on steps taken to address C&D concerns.