<p> CLINTON COUNTY FEDERAL FISCAL YEAR 2007 COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM FUNDING REQUEST FORM PROJECT SUMMARY</p><p>INSTRUCTIONS: The Clinton County Commissioners are accepting proposals for use of FY 2007 Community Development Block Grant funds. Completed project summary funding request forms must be returned to the Clinton County Planning Department, 232 East Main Street, Lock Haven, PA 17745 by 5:00 P.M. Friday December 15, 2006.</p><p>APPLICANT: (Please print or type) </p><p>Name: ______</p><p>Title: ______</p><p>Address: ______</p><p>Town, State and Zip: ______</p><p>Contact Person: ______</p><p>Telephone: ______</p><p>Fax : ______</p><p>Email Address: ______</p><p>PROJECT TITLE: ______</p><p>ESTIMATED COST: ______</p><p>CDBG FUNDS REQUESTED : ______</p><p>OTHER FUNDS : Committed Pending</p><p>Local Funds $______</p><p>Other Funds $______</p><p>TIME SCHEDULE: </p><p>Estimate duration of project, critical start of finish dates, and any other relevant periods.</p><p>______</p><p>______</p><p>______PROJECT STATEMENT: </p><p>Explain the problem in terms of magnitude and duration. Identify the cause of the problem. Attach any plans, budgets, citations, or other documentation. Describe the proposed project and how it will directly improve the problem. Identify streets or landmarks where the improvements are to be made. Be sure to indicate where the project extends into adjoining municipalities, if applicable. </p><p>Has an engineer or other consultant provided any technical assistance so far? ____Yes ____No</p><p>If yes, please describe. If no, describe how you arrived at the project cost estimates.</p><p>______</p><p>______</p><p>SOLUTION: </p><p>Explain the problem solution, what you propose to do, and how this action addresses the problem cause. Define the service area, and how many homes will be served. ______</p><p>______</p><p>______</p><p>______</p><p>Please attach a map identifying the project location and service area.</p><p>Has an engineer or other consultant provided any technical assistance? ____Yes ____No</p><p>If yes, Please describe. If no, describe how you arrived at the project cost estimates/funding amount.</p><p>______</p><p>______</p><p>Is the project likely to be completed without CDBG funding? ____Yes____ No</p><p>Please Note: If census data cannot appropriately be used to justify the fundability of an activity, a survey may be conducted to determine the percentage of low and moderate income people within the proposed activity's service area. Please contact the Planning Office for income survey guidelines. </p><p>Submitted By: </p><p>Signature of Chief Elected Official, Title Date </p>