American Rescue Plan Funding
Please complete the following form to apply for funding through Floyd County Government and the American Rescue Plan.
Section 1 - Worksheet
Project Name
*
Project Sponsor
Sponsor Point of Contact
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Please check category requesting funds
*
Support Public Health Response
Replace Public Sector Revenue Loss
Water and Sewer Infrastructure
Address Negative Economic Impacts
Premium pay for Essential Workers
Broadband infrastructure
For all Categories
Project Funding Request
*
Project Total Cost
*
Is Project leveraging other funding sources?
*
Yes
No
Please identify source and amount?
Project Scheduled to be completed:
*
-
Month
-
Day
Year
Date
Section 2 - Project Information
Please select
*
Request $25,000 Grant Financial Impact
Request $50,000 Grant COVID-19 Program
Project Narrative
Please provide a narrative on how the request for funding responds to the COVID-19 pandemic?
*
Please provide a narrative identifying the negative impacts from COVID-19 pandemic?
*
Please provide a narrative on how the proposed project mitigates the negative impacts of the COVID 19 pandemic?
*
Please provide a narrative on the need for the funding and explain why it cannot be received from other sources.
*
Does the project require user fees?
Yes
No
Please explain status regarding user permitting:
Project Sustainability:
*
Project Recipients:
Please identify the number of project recipients:
*
If using a Federal/State Grant/Loan Program, please identify amount and availability:
*
Please add any other pertinent information for review:
Submit
Should be Empty: