Please leave this field empty. Date

Municipality or Organization

Respondent

Position

Email

Phone

Amount of 2023 grant funding requested (not to exceed ($200,000):

What need(s) identified in the 2021-2025 Consolidated Plan does this project address?
Public Facility Project (building upgrade or rehabilitation)New Public Water and Sanitary Sewer ProjectUpgrade to Existing Public Water and Sanitary Sewer InfrastructureNeighborhood Infrastructure (streets, sidewalks, curbs, bridges, and related)

Has your organization received a public improvement grant from the Redevelopment Authority in the past three (3) years?
YesNoNot Sure

Briefly describe the project:

Please leave this field empty. Organization Name

Respondent Name

Respondent Title

Phone Number

Email