Letter of Support Request Form

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

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

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.

Name

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