(Federal Funds-95%) /
Date
Airport Name
Sponsor Name / CountyAddress / Phone
City, State, Zip / Fax
E-Mail Address
Contact Person’s Name / Title
Address / Phone
City, State, Zip / Fax
E-Mail Address
Proposed Project Funding
State block grant funds are federal funds administered by the state of Missouri, which are currently granted on the basis of 95% of the approved cost.
Breakdown of Local Amount
/Project Costs
Cash. Amount on deposit in airport account prior to execution of grant agreement will be at least $. / Total estimated project costs / $Federal Amount (95%) / $
Local Amount (5%) / $
Project Description
Proposed Construction:Other Proposed Improvements:
Project Readiness
/Yes
/No
Development is shown on an approved Airport Layout Plan (ALP). Date approved by MoDOT or FAA (circle one):Sponsor owns sufficient land for project.
Current Exhibit “A” Property Map/Certificate of Title.
Design plans ready for bidding.
Number of based aircraft. / Single Engine / Twin / Jet
Number of annual operations (An operation is either a takeoff or a landing).
Sponsor’s Representative
Typed or Printed Name and Title
/Signature
PLEASE MAIL COMPLETED APPLICATION TO:
MISSOURI DEPARTMENT OF TRANSPORTATION
AVIATION SECTION-MO
P.O. BOX 270
JEFFERSON CITY, MO 65102
FOR MoDOT USE ONLY
Facilities inspected by: / Date:Project considered: / Emergency / Routine
/
Yes
/No
Project qualifies as a Categorical Exclusion.EA underway for FONSI.
EIS complete awaiting FAA approval.
Sponsor certifies sufficient local funds.
Project Readiness Score: / Proposed Funding Year
Recommended: / Disapproved / Approved
Reason(s) for recommending disapproval: ______
______
______
______
______
Rev. 11/01/05