Letter of Support Request

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.

Applicant Mailing Address - Please include the mailing address of the applicant.

Address

Address 2

City

State

Zip Code(5-Digit)

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

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

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

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

Applicant Engineer/Consultant Other

If other, please explain your role.

PROJECT INFORMATION

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

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.

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

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

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

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

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

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

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

Type of Funding

Grant Loan Tax Credit Other

If other, please explain.

SUPPORT LETTER INFORMATION

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

Addressee Title - Please state the functional title of the addressee.

Addressee Mailing Address - Please state the mailing address of the addressee.

Address

Address 2

City

State

Zip Code(5-Digit)

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.

Support Letter Due Date - Please indicate the date (Month, Day, Year) by which the support letter is needed.

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.

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