Download a Word version of this application: plhd2011appl.docx, 21 KB
Project Location (Include City/County, State):
State Priority (to be completed by State DOT):
GRANTEE CONTACT INFORMATION
Grantee Contact Name:
Federal Agency/Project Sponsor:
Mailing Address (Street/P.O. Box):
City, State, Zip code:
STATE DOT CONTACT INFORMATION
State Contact Person:
FHWA DIVISION OFFICE CONTACT INFORMATION
Division Contact Person:
Congressional District No.:
TO BE COMPLETED BY THE FHWA DIVISION OFFICE
State Administered? Yes No
Federal Lands Division Administered? Yes No
If yes, which Division?
Direct Allotment of PLHD funding to Federal Agency? Yes No
If yes, which Federal Agency?
Can the project be obligated by September 30, 2011? Yes No
Date grant application approved by FHWA Division Office
(Maximum 5 sentences) Briefly describe the how PLHD Program funds will be used to support the proposed funding request.
(Maximum 2 pages) Describe how this funding request improves access to, within, or provides access to Federal lands or facilities and addresses one or more of the following eligibility categories identified below. Describe the project and the expected results, including project goals in context of the eligibility category selected, project schedule, and line item (scaleable) budget. Please associate each line item in the budget with a completed task, deliverable, or outcome that contributes to the completed funding request.
If applicable, describe how the project meets priority consideration criteria.
Describe how the project meets the project selection criteria
Discuss the project schedule, commitment of leveraged funding, both public and private, and any other PLHD or other Federal funding being used for the project. For applicants other than the State DOT, discuss coordination with State DOT and MPO, as well as ability to act on behalf of the applicant jurisdiction, and ability to meet Federal funding requirements.
Does the project within, adjacent to, or provide access to Tribal and/or Federal lands? Please identify which specific Public and/or Tribal land (i. e. Yellowstone National Park, Allegheny National Forest, BLM Lands, or Navajo Reservation).
If the project does not meet the above criteria, on what basis do you consider this project eligible?