Letter of Support Request Form

Company

This field is for validation purposes and should be left unchanged.

Applicant Information

Applicant Name - Please include the name of the government entity or organization who is applying for the funding and will serve as the recipient for the funds.(Required)

Applicant Mailing Address - Please include the mailing address (city, state, and zip code) of the applicant.(Required)

Street Address Address Line 2 City State ZIP Code

Support Letter Contact Person - Please include the name of the primary contact person for this request.(Required)

Support Letter Contact Person Phone Number - Please include the phone number of the primary contact person.(Required)

Support Letter Contact Person Email Address - Please include the email address of the primary contact person.(Required)

Support Letter Contact Person Role - Please choose which best describes the contact person.(Required)

Applicant

Engineer/Consultant

Other

Project Information

Name of Project - Please provide the name of the project that is the subject of the funding request.(Required)

Application ID Number (if applicable) - If an application has already been submitted, please provide the application ID number (if available)

County - Please state the county in which the project is located.(Required)

Municipality - Please state the municipality (city/borough/township) in which the project is located.(Required)

Brief Description of the Project - Please describe the project, including a description of how the requested funding will be used.(Required)

Brief Impact of the Project - Please describe the benefits of the project to the community.(Required)

Requested Amount - Please include the amount of funding requested in the funding application.(Required)

Total Project Cost - Please provide the total cost of the project.(Required)

Application (if applicable) - Please upload the project application if available.

Accepted file types: doc, pdf, jpg, docx, Max. file size: 4 MB.

Funding Program Name - Please provide the name of the funding program associated with this funding application.(Required)

Funding Source (department, agency, bureau, etc.) - Please name the agency that administers the funding program.(Required)

Type of Funding(Required)

Grant

Loan

Tax Credit

Other

Support Letter Information

Addressee Name - Please state to whom the support letter should be addressed.(Required)

Addressee Title - Please state the functional title of the addressee.(Required)

Addressee Mailing Address - Please state the mailing address (city, state and zip code) of the addressee.(Required)

Street Address Address Line 2 City State ZIP Code

Support Letter Handling Instructions

Support Letter Handling - Please provide the name and mailing address (if hardcopy) or email address (if electronic) of where the original support letter should be sent.(Required)

Support Letter Copies - Please provide the names and mailing addresses (if hardcopy) or email addresses (if electronic) of where support letter copies should be sent.(Required)

Support Letter Due Date - Please indicate the date by which the support letter is needed.(Required)

Other Specific Handling Instructions - Please add any other specific handling instructions for the letter. Ex.) If copies need to be provided to specific individuals please include all necessary information.