House Republican Bond Request Follow Up Form

House Republicans Bond Request Follow Up Form

Name of Person Completing Form(Required)

Email of Person Completing Form(Required)

Name of Project(Required)

Legislator(s) Requesting (if multiple legislators, please include all names)(Required)

Legislator(s) House District(Required)

Legislator Email(s) (if multiple legislators on request, please include all email addresses)(Required)

Project Description(Required)

Address of Project (Street, Address, City, Zip Code)(Required)

Legal Name of Entity Receiving Funds? (Legal name of organization)(Required)

Entity Type(Required)

Project Contact Name(Required)

Project Contact Email(Required)

Project Contact Phone(Required)

Total Amount Requested for Bonding(Required)

Total Cost of Project(Required)

Other Sources of Funding(Required)

Amount from Other Sources of Funding (please indicate what other sources and the amount, if there is more than one source, please list all)(Required)

Status of Other Funding(Required)

Project Status (i.e. current phase, permits received, designed, federal or local approval, ready for construction)(Required)

Please indicate the status level of project plans and construction(Required)

Please describe the status of any permit applications needed for the project. If none, please explain.(Required)

Please describe the status of any federal or local approvals required for the project.(Required)

Job Creation(Required)

Temporary (Construction jobs limited during time period of project)

Permanent (Employees/staff operating in a project after completion)

Benefits from this project (who does this project impact? serve? how? why is this important?)(Required)

Request Also Submitted in Senate?(Required)

Yes

This project is anticipated to begin upon receiving bond request (check one)(Required)

Anticipated completion date

Please provide any additional information that describes readiness.(Required)

A copy of your responses will be emailed to the address you provided.