Town of Pepperell Online Forms

2. Please note that if you cannot complete the submission in one session and need to save your draft make sure to click the SAVE PROGRESS button on top of this form and later navigate to https://town.pepperell.ma.us/formcenter or click the MYFORMS button on top to retrieve your drafts. 

4. Date:
   Date:
6. Project Title:
8. Project Street Address (if applicable):
10. Assessors Map Number:
11. Lot/Parcel Number:
13. Deed Book Number:
14. Deed Page Number:
16. Name(s) of Applicant/Contact Person and Project Manager:
18. Name of Organization:
20. Address:
21. Telephone:
23. Email:
24. Sponsoring Organization (if applicable):
26. CPA Category (check all that apply): Please use the chart at the end of this document for guidance.

    1. Open Space
    2. Recreation
    3. Historic Preservation
    4. Community Housing
28. Total Project Cost ($):
30. CPA Funding Request ($):
32. DETAILED NARRATIVE AND PROJECT DESCRIPTION:
    • All the following MUST be answered in the space provided, with attachments if needed.
    • Applications will be returned as incomplete if all relevant requested information is not provided.
    • Include supporting materials and exhibits as necessary.
    • A spreadsheet including the Budget and/or Timeline elements outlined in this application form is also acceptable.
    • Please refer to the Pepperell CPC Funding Application Packet, including Guidelines for Project Submission, Eligibility, and General Criteria, before and while completing this application.
    • At CPC discretion, more information may be required.

    
    

34. 1. Describe the project - short description (limited to 200 characters):
36. 2. Goals:
    1. What are the goals of the proposed project?
    2. Who will benefit from this project and why?
    3. How will success be measured?
38. 3. Which of the General Categories does this project fulfill and how?

    (Note: Should the application address multiple categories, please address all that apply to speed up the application process.) Please refer to the CPA allowable uses chart at the end of this application.

40. 4. Statement of Community Need:
    1. How does the Town of Pepperell and its residents benefit from this project?
    2. If applicable, explain how this project addresses need identified in existing Town plans. (i.e. most recent Master Plan, Open Space and Recreation Plan, Community Preservation Plan)

    
    

42. 5. Community Support:

    What is the nature and level of support? Include letters of support from any Town Committees, Boards, and Departments, as well as local community groups that have reviewed and endorsed this project.

46. 6. Budget
48. 6a) Budget Summary:
50. Total Project Cost: $
52. CPA Funds Requested: $
54. Cost Share Amount and Percent:
56. 6b) Itemization as required:
    • Provide a copy of the IRS non-profit number or W-9 form
    • Provide a copy of the most recent audit of prior year(s) finances (beneficiary to provide documentation)
    • Labor costs – prevailing wages
    • Equipment is generally defined as an item with a useful life expectancy of more than one year.
    • Supplies are defined as an item with a useful life of less than one year.
    • Construction means all types of work done on a particular property or building, including erecting, altering, or remodeling.
    • The cost share component is very important in giving the application a competitive advantage. Please identify the amount of cost sharing for this project. Sources include private, federal, state, or local government, or any other sources. Use additional pages as necessary.
    • Provide the CPA funds requested; other funds or sources in total.
    • NOTE: CPA FUNDNG FOR ANY CATEGORY REQUIRES COMPETITIVE BIDDING unless you can provide a sole source justification for any category.

    **Attach a minimum of one recent formal bid**

    
    

58. 6c) Cost Sharing
60. Source 1 Type (cash, in-kind, etc.):
61. Source 1 Amount:
63. Source 2 Type (cash, in-kind, etc.):
64. Source 2 Amount:
66. Source 3 Type (cash, in-kind, etc.):
67. Source 3 Amount:
69. 7. Funding
71. a. Note below and attach commitment letters from any source providing a cost share contribution as listed above.
73. b. Describe any other attempts (including unsuccessful ones) to secure funding for this project.
75. c. Are any “Other Funds” in the budget in-kind?

    If yes, describe how the value of the in-kind contribution was derived. (In-kind contributions can be defined as a contribution of services or property, donated equipment, buildings or land, or donated supplies.)

77. 8. Timeline

    Provide a schedule for the project implementation, including a timeline for starting and ending major tasks as well as a reasonable estimate for project completion. If the project is expected to take multiple years to complete, please bread down on a year-by-year basis.

79. 9. Maintenance
81. a. if ongoing maintenance is required, who will be responsible for it?
83. b. How will it be funded? (Note: CPA funds cannot be used for regular maintenance.)
85. c. Expected Annual Maintenance Budget (please include 5-year budget and documentation of commitment.)
87. Year one: $
89. Year two: $
91. Year three: $
93. Year four: $
95. Year five: $
97. 10. Project/Site Documentation (if applicable)
99. a. Note below and attach documentation that you have control over the site, such as a Purchase and Sale Agreement, option, or deed.
101. b. Note below and submit photographs of the “before” status of your via email to cpc@town.pepperell.ma.us with your electronic submission. If your application is approved, additional photographs of the completed project will be required. These photographs are needed for documentation of the use of Town funds and for use on the website.
103. c. Note below and attach any applicable engineering plans, architectural drawings, site plans, as well as any other renderings relevant studies, historical background summaries, or material
105. 11. Zoning Compliance: if applicable, note below and provide evidence that the project does not violate any Zoning by-laws or any other laws or regulations, including environmental. List permits or approval that may be needed.
107. 12. If there are any additional information that might benefit CPC in consideration of this project, please note below.
111. File Uploads

     If able to, please combine your multiple attachments into one .zip archive. 

113. File 1
114. File 2
116. File 3
117. File 4
119. File 5
120. File 6
124. Applicant's Name:
Leave This Blank:


126. 1. Receive an email copy of this form.
127. Email address

     This field is not part of the form submission.

128. Submit

* indicates a required field