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