DOT - TRANSPORTATION ALTERNATIVES FUNDING APPLICATION

TRANSPORTATION ALTERNATIVES FUNDING APPLICATION
North Dakota Department of Transportation, Local Government
SFN 62766

If you have questions on filling out the application or the program, please contact: TAProgram@nd.gov

Email Address of Contact Person to Receive Confirmation of the Completed Form

example@example.com

Project Name

Project Location

Requesting Agency

Name of Agency

Agency Contact Person

First NameLast Name

Agency Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Agency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Agency Contact Email Address

example@example.com

Project Sponsor

Project Sponsor Agency Type

Select the correct sponsor type.

Sponsoring Official's Name

First NameLast Name

Sponsoring Official's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Sponsoring Official's Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Sponsoring Official's Email Address

example@example.com

Project Details

Project Description

Eligible Project Costs

Ineligible Project Costs

What TA category best fits your project?

Is your project part of an identified recreation or transportation plan?

Is your project tied to another project?

How does your project fit with similar projects in your community and/or region?

Provide documentation from government agencies supporting this project. Please also provide documentation of any support from the general public, other groups, and organizations.

Is this property accessible to the public?

Who are the matching funds being provided by?

Will right-of-way be needed for this project?

Maintenance for this project will be provided by:

Environmental Impacts

Land Use - Describe changes or potential changes this project will have upon land use in the vicinity.

Farmland - If any farmland is to be used for this project, identify what its present usage is.

Social - Describe the project's impact upon the neighborhood and community.

Section 4(f) & 6(f) - Are there any impact to Section 4(f) or Section 6(f) properties?

Economic - Describe the project's economic impact.

Relocation - Will this project require the displacement of any people or businesses?

Wetlands - Will this project result in fill material being placed in any wetlands?

Floodplain - Is this project located within a floodplain?

Threatened or Endangered Species - Are there any threatened or endangered species in the project vicinity?

Cultural Resources - Are there any properties on or eligible to be on the National Register of Historic Places in the project vicinity?

Hazardous Waste - Are there any hazardous waste sites in the project area?

Other - List any/all other environmental impacts not listed.

Attachments - please include maps and any other supporting documentation in PDF format here.