Date:

Name of Applicant/Organization:

President/Chairperson (If applicable):

Address: (Number) (Street)

(City)                       (State)             (Zip)

Phone Number (Day):

Phone Number (Evening):

E-mail:

Name and Short Description of the Project:

Neighborhood and/or Physical Location of the Project:

Total Project Cost:

Amount Requested from NIP:

Estimated Project Start Date:

Estimated Project Completion Date:

Has your organization applied for Neighborhood Improvement Program funding previously?

   Yes      No    If “Yes” please indicate when and the name of the project:

PLEASE PROVIDE A DESCRIPTION OF THE PROJECT

DESCRIPTION OF THE APPLICANT

Please provide a brief description of your organization; how is it organized, how long it has been established, etc.  Applicant should demonstrate how the project will be managed by the organization and how the match requirements will be met in a timely manner.

We are a:

 Neighborhood Association

 Neighborhood Watch Group

 Homeowners Association

 Committee of Concerned Citizens

NEIGHBORHOOD INVOLVEMENT

Please describe how involvement from the neighborhood residents was obtained in the selection of this project.  Include documentation showing the neighborhood involvement such as neighborhood flyers, minutes of any meetings where the project was discussed, sign-in sheets, etc.

WHAT WILL THE PROJECT ACCOMPLISH

Please describe what need this project addresses and how the neighborhood will benefit from the project.  Will there be any spillover benefits to the Town?  If possible please provide specific numbers of persons benefiting or other measures to demonstrate the success of the project. 

FUTURE MAINTENANCE OF THE PROJECT

If you are proposing a physical project such as a neighborhood sign or landscaping /beautification project please describe how the project will be maintained once the project is completed.  If the project is organizational in nature describe how you plan to maintain what is gained from the project after it is completed.    

MATCH REQUIREMENTS

Applicants requesting funding under the Neighborhood Improvement Program must provide a 100% match ($1.00 in matching funds for each $1.00 requested in funding).  The match provided must be directly related to the project being undertaken.  Matching resources may include the following:

·          Cash contributions;

·          Donated or Discounted Materials or Services, provided that price quotes are provided from the vendor substantiating the value of the item(s);

·          Donated land, with assessment information documenting the value of the donation;

·          Donated professional services, such as architectural, engineering, construction, etc., valued at the full cost of the service provided;

·          Volunteer labor, valued at $16.25 per hour.

Briefly describe the matching resources you have identified to meet the match requirement

BUDGET WORKSHEET

The Budget Worksheet may be found on the following page.  The budget should provide a total picture of your project and the resources needed to complete it.  All related costs must be covered in the budget.  The applicant is required to identify the source of funding for each line item with an explanation if necessary.  The value and type of any in-kind contributions should be thoroughly explained and should include supporting documentation as needed.  Your budget should clearly relate to the activities described in your project description.

Instructions for completing the Budget Worksheet:

(A)      Budget Item:  Provide a brief description of each item needed to complete the proposed project, including labor and materials.

(B)      Actual Cost:  The actual cost or value of the item.  Please detail material and labor costs separately where applicable.

(C)      Requested in Matching Grant Funding:  Amount of money requested for each line item from Neighborhood Improvement Program funds

(D)      Matching Resources Provided by the Applicant:  Indicate the value of the matching resources being provided by the applicant through volunteer labor, cash donations, donated goods or services, etc.

Note for Columns (C) and (D):  Some budget line items may be entirely funded by Neighborhood Improvement Program funds or by Matching resources.  Each line item does not need to show a 100% match.  Match requirements only apply to the total project cost.

(E)       Specify Matching Resources:  Indicate the source of the volunteer labor, cash donation, discount in material costs, etc.  If donated or discounted materials or services, identify vendor.

(F)       Total:  The Total is the sum of columns (C) and (D).

BUDGET WORKSHEET

            Applicant:

Name of Project: UDGET WORKSHEET BUDGET WORKSHEET

Funding Sources

(A)

Budget Item

(B)

Actual Cost

(C)

Amount Requested in NIP Grant Funding

(D)

Matching Resources Provided by Applicant

(E)

Specify Matching Resources

(F)

TOTAL

(Sum C+D)

 TOTALS:

(Column D should equal or exceed Column C)