California Community Economic Revitalization Team
|
California Community Economic Revitalization Team |
Concept Project Proposal Summary |
|
County __________________ Project #__________________ Date__________________ Northwest Economic Adjustment Initiative Concept Project Proposal Summary (Print or Type Legibly in the space provided) Note: Proposals and any accompanying documents are subject to the California Public Record Act and the Freedom of Information Act. This form does not constitute a legal preapplication. Concept proposal summary will be shared with various agencies which have loan and or grant programs.
1. Applicant_____________________________________
2. Contact name__________________________________________ Address______________________________________________ City, State, Zip________________________________________________ Phone #___________________________________Fax:________________________
3. Project Title _____________________________________
4. Project Type (Check the most appropriate ONE)
______ Business & Industry
A)________ for Profit (financial assistance directly to businesses for fixed assets or working capital). 1)_________ Existing Business 2)_________ Start-up Business B)________ Non-Profit (local revolving loan funds, technical assistance).
______ Community Infrastructure (Assistance for publicly owned infrastructure, such as water and sewer; and public facilities, such as business incubators needed for community well being).
______ Workers & Families (Projects which prepare impacted timber workers and eligible family members for work by increasing occupational and educational skills. Training services may include job search assistance and supportive services).
______ Technical Assistance (Planning, studies, marketing, and other programs to improve the public sector's capacity to engage in economic development or to stimulate the private sector to invest in the community, county, or region). ______ Ecosystem Enhancement ($ resource surveys, inventories, studies, research, monitoring, activities, and opportunities; environmental education; structures or non-structural improvements; restoration of degraded resources - aquatic or terrestrial).
A)_________ On Private Land B)_________ On Public Land 1)_________ Federal 2)_________ State 3)_________ Tribal
5. Project located in what geographic area:_______________________________ List other geographic areas which may benefit, if applicable
6. Identify if this proposal has been submitted to any agency(ies) and date of submittal: _________________________________________________
7. Proposed budget A) Amount requested $________ B) Amount of local match $________ C) Total project cost $________ D) Length of project ________ (Please remember that public agencies cannot make multi year funding commitments {businesses and private sector financing excepted}) 8. How many and what type of jobs do you expect to create/retain with the project (if applicable)? A) Within the first year of project completion Construction ________ Wage ________ Seasonal ________ Wage ________ Part-time permanent ________ Wage ________ Full-time permanent ________ Wage ________ B) Within three years of project completion. Seasonal ________ Wage _________ An. Salary ________ Part-time permanent ________ Wage _________ An. Salary ________ Full-time permanent ________ Wage _________ An. Salary ________
For questions 9-17 a narrative may be attached, provided that the narrative answers the questions listed below. If the narrative does not cover a question please use the space provided to include that information. 9. Project description:
10. Explain how this project is important to the community:
11. What are the anticipated benefits of this project (i.e. - job creation/job retention, development of business and industry, assistance to dislocated workers and their families, improvement of public facilities, etc.).
12. Qualification, training, or experience with similar businesses or projects: (including management background).
13. Please describe any other groups, agencies, or individuals that have or will contribute time, money, equipment or other necessary items to make this project a success.
14. What efforts have you taken, to date, regarding this project (i.e. - research, prior financing, prior grants or fundraising, licensing, purchases, etc.).
15. Are there any other factors significant to this project we should be aware of?
16. What supporting documents do you have? List by document with date and author (DO NOT include document with this proposal).
|