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APPLICATION FORM LC-CRP-1

SECTION 1. APPLICANT INFORMATION

Applicant
Federal ID Number
Tax Exempt ID Number
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone
Fax
Email
Project Coordinator

SECTION 2. PROJECT INFORMATION

Project Title
Project Property Is Owned By
Location Nearest Road & Intersection
Property Acreage
County Property Identification Number (PIN) (if applicable)

SECTION 3. PROJECT FUNDING

Community Re-invest Program Funds Requested
* Other Funding Sources
Local Match
Total Project Cost

* Please list all other funding sources & amounts

SOURCE AMOUNT

SECTION 4. SCOPE OF WORK

In this space, provide the project scope of work and description of how the project will benefit the community and improve the quality of life.

SECTION 5. PRIORITIZATION (County use Only - Do Not Complete This Section)

Has the applicant sought other funding sources for the project?
YesNo
Type of Project (Benefit)
Open SpaceGreenways and TrailsOutdoor RecreationCommunity Services / Quality of LifeInfrastructure
Has the applicant secured other funding sources for the project?
YesNo

SECTION 6. PROJECT BUDGET

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