Request a Letter of Support

APPLICANT

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.

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

Address

Address Line 2

City

State

Zip Code

Contact Person Phone Number

Contact Person Email Address

GRANT/LOAN

Project Name

Application ID Number, if application submitted

Municipality

County

Requested Amount

Total Project Cost

Funding Program

Funding Department, Agency, Bureau, etc.

Brief Description of the Project

Brief Impact of the Project

Type of Funding

Grant Loan Tax Credit Other

If Other, please describe

SUPPORT LETTER

Support Letter

Yes No

Support Letter Contact Person Role

Applicant Engineer/Consultant Other

If Other, please describe

Support Letter Handling - Please provide the name and mailing address (if hardcopy) or email address of where the original support letter should be sent.

Support Letter Extra Copies - Please provide the names and mailing addresses (if hardcopy) or email addresses of where support letter extra copies should be sent.

Support Letter Name - To whom would you like electronic/mailed letters directed?

Support Letter Title

Support Letter Email

Support Letter Address

Support Letter Address Line 2

Support Letter City

Support Letter State

Support Letter Zip Code

Support Letter Due Date (MM/DD/YYYY)

*If application has been submitted, please provide a copy to Melissa Corbin at mcorbin@pahousegop.com

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